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Lli^RARY 

UNIV6SSITY  OF 

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SAN  DIE90 


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3   1822  01074   9786 


DATE  DUE 

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APK             "40 

MAR  7 

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SIR    VICTOR    HORSLEY 


SIR  VICTOR  HORSLEY 

A   STUDY    OF   HIS   LIFE   AND   WORK 

BY 

STEPHEN    PAGET 


Misit  de  summo,  et  accepit  me  : 
et  assumpsit  me  de  multis  aquis. 

My  sword  I  give  to  him  that  shall  succeed  me  in  my  pilgrimage, 
and  my  courage  and  skill  to  him  that  can  get  it. 


ILLUSTRATED 


NEW    YORK 

HARCOURT,    BRACE    AND    HOWE 

I  920 


Printed  in  Great  Britain 


TO   LADY   HORSLEY 


PREFATORY    NOTE 

By  Lady  Horsley 

When  at  the  age  of  fifty-nine  Victor  Horsley  died,  struck 
down  by  the  furnace  heat,  the  mental  misery,  and  the  over- 
work of  Mesopotamia,  he  was  still  in  the  fulness  of  his 
powers.  These  he  had  planned  to  use,  on  his  return  home, 
for  the  promotion  of  the  social  reforms  in  wliich  he  was 
most  keenly  interested,  the  health,  housing,  and  land  of 
the  people.  He  intended  again  to  offer  himself  for  Parlia- 
mentary election  and,  as  the  letter  from  Huddersfield  quoted 
in  the  Memoir  shows,  he  would  probably  have  been  returned 
to  Parliament  by  a  constituency  choosing  him  as  their 
representative  for  his  personal  qualities  and  his  high 
ideals. 

He  belonged  to  a  long-lived  family.  He  was  himself  strong 
and  vigorous.  He  would  under  normal  circumstances 
probabl}'  have  lived  to  old  age,  and  so  long  as  strength  of 
mind  and  body  remained  to  him  it  would  have  been  used 
in  attempting  to  further  the  interests  of  the  people.  And 
he  would  have  furthered  them.  He  possessed  in  a  high 
degree  the  power  of  influencing  other  men,  and  not  only 
those  of  his  own  age  but  also  the  young,  a  much  rarer  gift. 
Th«n'  felt  that  he  was  not  of  the  past  or  even  of  the  present 
but  of  the  future,  and  that  his  leading  was  always  onwards 
and  upwards.  When  he  joined  a  cause,  his  name  at  once 
added  strength  to  it.  It  could  not  be  merely  sentimental, 
or  wanting  in  justification,  if  it  had  attracted  to  it  so  manly 
a  man  and  so  keen  an  intellect.  Thus  he  would  have  been 
a  teaching  and  inspiring  force  in  the  coimtry,  and  he  has 
left  a  void  which  so  far  no  one  has  come  forward  to  fill. 

It  seemed  wrong,  when  all  this  vitality  and  power  was 
so  suddenly  arrested,  that  no  effort  should   be  made  to 

vii 


viii  SIR  VICTOR  HORSLEY 

set  forth  his  Ufe  and  labours  as  an  incentive  to  others  to 
take  up  the  work  he  had  too  early  laid  down. 

The  task  however  of  preparing  such  a  record  was  a  very 
arduous  one,  for  probably  few  men  who  have  done  so  much 
have  written  so  Uttle,  and  it  needed  all  Mr.  Paget's  literary 
powers  and  enthusiasm  for  his  theme  to  overcome  the 
difficulties  which  confronted  him. 

The  sincerity  of  that  enthusiasm  no  one  can  doubt  who 
read  his  words  when  the  news  came  from  Amarah  in  1916. 
Yet  it  would  be  hard  to  find  two  men  of  goodwill  more 
widely  separated  in  their  mental  attitude  than  the  author 
of  the  Memoir  and  the  subject  of  it.  They  differed  in 
religious  convictions,  in  politics,  in  social  ideas,  in  their 
ways  of  approaching  men  and  matters,  and  these  differ- 
ences constantly  make  themselves  apparent  in  the  book 
and  in  the  critical  attitude  of  the  author. 

Nevertheless  no  attempt  has  been  made  to  suppress  or 
soften  this.  Those  who  regard  Victor  Horsley's  memory 
with  most  reverence  and  most  affection  are  well  content  to 
let  his  life  speak  for  him  and  to  let  those  who  read  it  judge 
for  themselves.  The  object  of  the  book  will  have  been 
sufhciently  attained  if  it  serves  to  preserve  an  influence 
that  was  never  more  needed  than  it  is  now  at  this  most 
critical  hour. 

June,  1919. 


ERRATA 

P.  119,  line  3.        False  quotation. 

P.  126,  line  13.     For  'Army'  r^t?^  '  Navy.' 


CONTENTS 


PART   I 

SCIENCE   AND    PRACTICE 

CHAP.  PAGE 

I.  From   1S57  to  1873    ....  3 

II.  Fro.m  January  1874  to  September  1878    .  .         15 

III.  From  October  1878  to  May  1881  .  .27 

IV.  From  1881  to  1884  .....         39 
V.  The  Cure  of  Myxcedema     .            .             .  .54 

VI.  The  Prevention  of  Rabies              .            .  .68 

VII.  The  Localisation  of  Function  in  the  Brain  90 

VIII.  From  1885  to  1887  .            .            .            .  .114 


PART    II 

SCIENCE   AND    PRACTICE.     PROFESSIONAL    POLITICS. 
PUBLIC    LIFE 


I.  From   1888  to  1892    . 

II.  From   1893  "^o  ^^98   . 

III.  From    1899  to  1906  . 

IV.  From   1907  to  August  19 14 
V.  Professional  Politics 

VI.  The  Fight  .\gainst  Alcohol 

VII.  Brotherhood  Addresses 

VIII.   Private  Practice.     Homk  Lifi- 

b 


133 

149 
167 
r86 
2 1  2 
230 

255 
263 


SIR  VICTOR  HORSLEY 


PART    I  I  I 
DURING   THE   WAR 

CHAP.  PAGE 

I.  London.  Wimereux  .....  285 

ir.  Egypt  .......  295 

III.  India.     Mesopotamia  .....  313 


Published  Writings    .  .  .341 

Index    .  .  35 i 


LIST  OF  FULL-PAGE  PLATES 


Sir  Victor  Horsley 

Mr.    and    Mrs.   J.    C.    Horslf.y    in    the    Din'ng 

ROOM    AT    WiLLKSLEY  ... 

Victor  Horsley  at  the  age  of  Elf  yen  . 
Myxcedema  before  Thyroid  Treatment    . 
Same  Patient,  after  Treatment   . 
Pointed  (Service)  Bullet,  "22  calipre.     Cast  o 

Effect  in  Clay  .... 
•310  Soft  Lead  Bullet.     Cast  of  Effect 
The   Operating  Theatre,  Queen  Square,  1906 
Horsley's  Room,  University  College 
Drink  Shops,  Southwark,  19 14.     Tapard  Street 

District  ..... 
Sir  Victor  Horsley 
Sir  Victor  Horsley's  Grave  at  Amarah. 


Frontispiece 

facing  page    6 

54 
54 

155 
155 
184 

,,       200 

230 
„       285 


LIST  OF  ILLUSTRATIONS  IN  THE  TEXT 


Diagram    showing    the    Influence  of  Muzzling  over 

Rabies    .  .  .  .  .  .       87 

Diagram  of  the  Dog's  Brain,  showing  the  five  'Motor 

Centres'  localised  by  Fritsch  and  Hitzic,  1S70        93 
Motor  Region  of  Cerebral  Cortex  (external suriace)       98 
Motor    Region  of  Cerebral  Cortkx  (mesial  suhack)       99 
Drawing    made    during    Experiment   on    the    Motor 
Region   ok  the  Cerebral  Cortex   ok   an    Orang- 
outang   .......     108 

Facsimile  of  Horsley's  Rebus        .  .129 

Sketches  in  Letters  from   France  and  Mesopotamia, 

292,  320,  ■?2i,  324,  725.  327,  330,  332,  33  ^  \\.\,  335 


TO 

WILLIAM  W.  KEEN.  M.D.,  LL.D., 

EMERITUS  PROFESSOR  OF  SURGERY,  JEFFERSON 

MEDICAL  COLLEGE  ;  LATE  PRESIDENT,  AMERICAN 

PHILOSOPHICAL  SOCIETY. 

Dear  Dr.  Keen, — When  this  book  was  published  in 
England,  Lady  Horsley  let  me  dedicate  it  to  her. 
In  America,  it  dedicates  itself  to  you,  of  its  own 
accord,  without  asking  my  leave.  Your  name  and 
your  work  are  familiar  to  us  over  here ;  you  knew 
Victor  Horsley  well :  you  and  he  stood  side  by  side 
for  the  advancement  of  surgery  :  and  you  are  a  true 
lover  of  England.  No  wonder  that  the  book  takes 
this  opportunity  of  dedicating  itself  to  you  :  and  I 
admire  tlic  wisdom  of  its  choice. — Yours  very  truly, 

Stephen  Paget. 

LiMPEFiELD,  Surrey, 
December  1919. 


PART    I 

SCIENCE    AND    PRACTICE 


From  1857  to  1873 

It  was  part  of  the  happiness  of  Victor  Horsley's  hfe  that  he 
was  of  good  birth  and  had  a  family  record  to  be  proud  of. 
He  was  a  son  of  John  Callcott  Horsley,  the  artist,  and 
a  grandson  of  William  Horsley,  the  musician.  WiUiam 
Horsley  married  a  daughter  of  John  Wall  Callcott,  the 
musician,  brother  of  Sir  Augustus  Callcott,  the  artist.  One 
of  William  Horsley's  daughters  married  Isambard  Brunei, 
the  engineer  :  another  married  Dr.  Seth  Thompson  :  another, 
Miss  Sophy  Horsley,  a  woman  of  keen  intellect,  and  a  notable 
pianist,  was  a  great  friend  of  Mendelssohn  ;  he  dedicated 
some  of  his  works  to  her. 

Victor  Horeley's  mother  was  a  sister  of  Sir  Francis 
Seymour  Haden,  the  surgeon  and  artist  who  was  founder 
and  first  President  of  the  Royal  Society  of  Painter-Etchers. 
She  was  a  daughter  of  Charles  Haden,  a  surgeon  in  good 
practice  in  Sloane  Street  :  he  was  a  great  friend  of  Miss 
Austen.  He  died  young,  but  not  before  he  had  made  a 
name  in  his  profession.  He  was  a  son  of  Thomas  Haden  of 
Derby,  one  of  the  foremost  surgeons  in  the  provinces. 
There  is  a  well-known  etching  of  Thomas  Haden,  by  his 
grandson  Seymour  Haden,  after  a  portrait  by  Wright  of 
Derby. 

John  Callcott  Horsley  was  born  in  1817,  in  Brompton. 
Six  years  later,  the  family  moved  from  Brompton  to  the 
house  which  now  is  128  Church  Street,  Kensington,  but 
then  was  i  High  Row,  Kensington  Gravel  Pits.  This  was 
Mr.  Horsley's  home  in  London  for  eighty  years,  from  1823  to 
his  death  in  1903.  Near  the  end  of  his  long  life  he  wrote  his 
Recollections  of  a  Royal  Academician.  The  surroundings 
of  the  house  have  changed  for  the  worse,  but  it  still  has  an 


4  SIR  VICTOR  HORSLEY 

air  of  quiet  dignity,  and  there  is  a  garden  behind  it,  and 
Kensington  Gardens  and  Kensington  Palace  are  not  far  off. 
He  could  remember  the  Princess  Victoria  riding  daily  past 
the  house  : 

It  was  a  charming  sight  to  see  them  scampering  up  Church 
Lane  at  a  hand-gallop,  passing  the  woodland  Campden  Grove, 
past  old  Campden  House  and  its  entrance-gates — and  the 
Princess,  who,  of  course,  led  the  cavalcade,  with  a  cool  and 
experienced  equerry  at  her  bridle-hand,  pulling  up  at  the 
turnpike  gate,  which  barred  the  road,  just  opposite  the 
stable  gate  of  No.  i  High  Row. 

He  was  a  student  at  Sass's  Academy  when  he  was  only 
thirteen  years  old.  In  1831,  he  became  a  Royal  Academy 
student.  In  1845,  he  was  chosen  to  paint  two  of  the  wall 
pictures  in  the  new  Houses  of  Parhament.  He  was  elected 
A.R.A,  in  1855,  and  R.A.  in  1864,  and  was  Treasurer  of  the 
Royal  Academy  from  1882  to  1897.  His  early  picture, 
'  Rent  Day  at  Haddon  Hall,'  brought  him  praise  and  success : 
he  loved  to  study  Haddon  Hall,  and  it  influenced  much  of 
his  work.  One  of  his  pictures  was  placed  in  his  hfetime — 
a  very  exceptional  honour — in  the  National  Gallery.  And 
he  did  a  memorable  service  to  art  in  England,  for  it  was  he, 
more  than  anybody,  who  organised  the  Winter  Exhibitions 
ot  Old  Masters  at  Burlington  House,  He  was  a  member  of 
the  Exhibitions  Committee  for  twenty-seven  years  ;  and  he 
delighted  in  the  duties  \vhich  it  put  on  him.  He  had  to 
visit  private  collections,  persuading  the  owners  of  master- 
pieces to  lend  them,  and  refusing  all  that  was  not  worth 
showing  ;  and  he  made  the  Winter  Exhibition  the  chief 
event  of  the  London  year  for  lovers  of  good  pictures. 

He  was  twice  married  :  his  first  wife  was  Miss  Elvira 
Walter  ;  three  children  were  bom  to  them.  She  died  of 
consumption  ;  and  her  children  did  not  long  outhve  her : 
all  three  of  them  died  of  scarlet  fever.  In  1854,  he  married 
Miss  Rosamund  Hadcn.  Seven  children  were  bom  to  them  : 
Walter,  Hugh,  Victor,  Emma,  Fanny,  Gerald,  and  Rosamund. 
Two  of  them,  Hugh  and  Emma,  died  in  childhood  of  scarlet 
fever.  Geiald,  the  architect,  died  in  July  1917.  The 
members  of  the  family  now  are  Colonel  Walter  Horsley,  the 


FROM  1857  TO  1873  5 

artist,  Lady  WTiitelegge  (Fanny),  and  Mrs.  Francis  Gotch 
(Rosamund). 

Victor  was  bom  on  April  14,  1857.  It  was  the  day  on 
which  the  Princess  Beatrice  was  bom  ;  and  the  Queen,  who 
had  kindly  regard  for  the  family,  noted  the  coincidence,  and 
sent  word  that  she  wished  him  to  be  named  after  herself. 
He  was  presented  to  her,  at  a  very  early  age.  Victor 
Alexander  Haden  Horsley — but  there  never  was  a  man  who 
made  less  use  of  a  superfluity  of  Christian  names.  From 
six  to  eighteen,  he  gradually  reduced  them  :  Victor  A. 
Haden,  Victor  A.  H.,  V.  A.  H.  By  the  time  when  he  was 
twenty-one,  the  A  and  the  H  were  gone. 

In  1858,  Mr.  Horsley  bought  a  country-house,  Willesley, 
near  Cranbrook,  in  Kent.  He  writes,  in  his  Recollections,  of 
the  beauty  of  the  place  : 

WTiere  's  Cranbrook  ?  I  remember  saying  to  old  Tom 
Webster  one  day,  when  he  told  me  he  was  going  down  into 
Kent  to  see  the  young  artist,  F.  D.  Hardy,  who  was  painting 
the  cottage  interiors  in  the  neighbourhood.  .  .  .  One  of  the 
most  picturesque  old  houses  in  the  High  Street  became 
Webster's  studio,  when,  at  a  later  date,  he  lived  no  longer  in 
the  farmhouse,  but  in  a  square  and  substantial  red-brick 
house  in  the  town.  Tempted  by  Webster's  account  of  Cran- 
brook, we  went  there,  and  often  occupied  lodgings,  till  the 
chance  came  of  buying  an  old  house  standing  about  half  a 
mile  out  of  the  towTi  on  a  hill. 

The  house  was  enlarged  and  decorated  by  young  Mr. 
Norman  Shaw.  Oak  panelling,  sixteenth-century  stamped 
leather  from  a  French  chateau,  curtains  from  a  palace  in 
Venice,  were  bought  or  given  for  its  adomment  : 

It  was  Norman  Shaw  himself  who  first  drew  bold  designs 
on  the  soft,  new  plaster  of  the  ceiling,  and  who  was  delighted 
to  find  his  ideas  ably  and  conscientiously  carried  out  by  the 
rustic  '  Men  of  Kent,'  the  Cranbrook  workmen,  with  a  skill 
and  verve  that  could  never  have  been  found  in  Londonci^i  of 
the  same  calling.  He  made  the  delightful  design  on  the 
gable  of  tlic  j)c;icock,  and  the  familiar  words,  '  K.xccjjt  the 
Lord  build  the  house,  their  labour  is  but  lost  who  build  it.' 

This  pleasant  country  house  is  still  in  the  family  :  Colonel 
Walter  Horsley  lives  there.     It  gave  the  children  all  that 


6  SIR  VICTOR  HORSLEY 

they  could  desire.  They  had  also,  on  this  or  that  occasion, 
a  holiday  at  the  seaside  ;  and  their  mother  once  took  them 
to  Boulogne,  but  the  lodging-house  was  so  dirty  that  she 
whirled  them  back  to  England.  They  did  not  lose  any- 
thing :  no  sensible  child,  having  Willesley  to  play  with, 
would  care  to  play  with  Boulogne.  After  1873,  the  house 
in  Kensington  became  home  to  them,  and  Willesley  was 
kept  for  hohdays  ;  but  up  to  1873,  they  were  always  in  the 
country. 

The  Recollections  of  a  Royal  Academician  are  good  read- 
ing ;  but  it  is  an  old  man's  book :  it  does  not  say  much  about 
the  home  hfe  at  Willesley  in  the  earlier  years.  Mr.  Horsley 
was  a  man  of  restless  energy,  impulsive,  hot-tempered,  but 
generous  and  quick  to  make  amends.  He  worked  hard, 
and  was  intolerant  of  any  break  in  his  work.  He  loved 
company,  and  was  bored  by  solitude.  His  letters  to  his 
wife  are  full  of  weathercock  changes  of  thought,  sharp  httle 
criticisms,  and  spurts  of  slang  and  chaff :  he  tells  her  all 
about  home  and  the  children,  what  they  are  all  doing,  how 
he  is  getting  on  with  his  work  :  for  instance,  what  a  friend 
has  paid,  at  a  sale,  for  one  of  his  pictures — '  An  old  stoopid  : 
I  'd  have  painted  him  a  much  better  picture  same  size  for 
the  money.'  Over  small  grievances  and  small  domestic 
perplexities,  he  was  fidgety  :  he  liked  to  arrange  and  plan 
everything,  and  to  have  it  just  so.  Over  greater  troubles, 
he  was  more  patient.  In  rehgion  and  in  poUtics,  he  stood 
on  the  old  ways  of  unquestioning  faith  and  of  loyalty  to  the 
Sovereign.  His  friendships  were  in  art  and  music,  not  in 
politics,  nor  in  science  :  he  was  averse  from  the  revolutionary 
spirit  which  was  refashioning  the  world  all  round  him  : 
neither  Huxley  nor  the  Pre-Raphaelites  found  their  way  to 
him.  But  that  which  told  against  his  authority  among 
artists  was  not  his  dislike  of  Pre-Raphaelitism,  but  his  dread 
of  the  influences  of  the  French  Salon,  and  his  opposition  to 
the  study  of  the  naked  model.  He  said  what  he  thought  of 
it  all,  in  1885,  in  the  Times  ;  and  there  was  a  good  deal  of 
rather  angry  laughter  over  that  controversy. 

It  would  be  waste  of  time  to  try  to  decide  what  in  Victor 
was  Horsley  and  what  was  Haden.     He  got  his  good  looks 


FROM  1857  TO  1873  7 

from  his  father.  If  we  may  go  by  the  evidence  of  hands, 
both  famihes  were  represented  in  him.  The  Horsleys  were 
proud  of  their  hands,  the  long  slender  fingers  and  well- 
shaped  nails  :  the  Hadens  had  square  hands,  with  square 
nails  :  as  Se^Tnour  Haden  said  of  an  old  portrait,  '  That 's 
the  woman  who  brought  the  damned  ugly  hand  into  the 
family.'  Victor's  hand  was  a  blend  of  the  two  :  it  was 
rather  square,  but  with  well-shaped  fingers  and  nails.  His 
mother  had  a  thoroughly  Haden  hand.  She  was  very 
skilful  and  very  practical  with  her  hands  :  for  forty  years, 
she  made  the  costumes  for  Mr.  Horsley's  models,  and  she 
could  deal  as  cleverly  with  carpenter's  tools  about  the  house 
as  \\ith  needle  and  scissors.  She  was  small  of  stature  ; 
busy,  strong-willed,  capable  :  as  Victor,  in  the  later  years, 
said  of  her,  '  She  used  to  make  things  go.'  She  could  be 
rather  terrible  toward  an  offending  servant  or  tradesman  : 
nor  did  the  children  find  it  easy,  as  they  grew  up,  to  adapt 
themselves  to  her  frequent  censure.  She  bore  pain  and 
faced  operations  with  extraordinary  courage,  but  was  not 
free  from  that  sort  of  timidity  which  then  was  more  common 
among  women  than  it  is  now — the  fear  of  dark  nights, 
horses  and  cows,  hansom  cabs,  and  so  forth.  She  had  been 
brought  up  in  France,  and  mostly  had  hved  in  France  to  the 
time  of  her  marriage  :  she  knew  French  history  as  it  were 
by  heart,  and  all  the  intricacies  of  the  French  dynasties. 
She  was  on  the  alert,  even  when  she  was  more  than  eighty 
years  old,  over  points  of  history ;  and  her  talk  with  its 
wealth  of  memories  was  of  great  interest.  In  society,  she 
liked  to  keep  herself  to  herself,  and  did  not  go  out  of  her  way 
to  make  new  friends  :  the  circle  of  art  and  music  round  her 
in  London  was  wide  enough  without  that.  In  all  affairs 
of  manner  and  of  conduct,  she  maintained  the  high  standard 
of  the  Victorian  Age,  and  the  rigid  observance  of  proprieties  ; 
but  was  none  the  less  independent,  and  proud  of  her  inde- 
pendence, hating  to  feel  herself  beholden  to  anybody. 
Toward  her  husband,  she  was  of  one  mind  with  him  over  the 
great  things,  but  was  more  apt  than  he  to  leave  the  lesser 
things  to  shape  themselves  ;  and  he  sometimes  was  vexed 
that  she  was  so  philosophical. 


8  SIR  VICTOR  HORSLEY 

It  was  inevitable,  from  the  tragedy  of  his  first  marriage, 
that  they  should  be  incessantly  anxious  over  their  children's 
health.  '  I  am  sorry  for  being  so  fussy,'  he  writes  to  her, 
'  but  if  I  hear  of  anything  being  the  matter  with  the  children, 
it  is  as  if  a  knife  were  driven  into  me.'  Except  for  this 
persistent  watchfulness,  the  children  had  nothing  or  next  to 
nothing  to  complain  of.  Obedience  was  expected  of  them, 
and  they  were  taught  to  be  content  with  simple  food,  and 
to  respect  the  difference  between  their  parents  and  them- 
selves ;  there  was  not  the  present  equality  or  pretence  of 
equahty  ;  they  did  not  offhand  invite  their  parents  to  play 
games  and  share  secrets  with  them  ;  but  they  had  all  the 
freedom  that  was  usually  given  to  the  children  of  that 
generation,  and  more  than  some  children  would  have  dared 
to  ask  for.  On  Sunday — that  everlasting  test  of  home  life — 
they  had  to  go  to  church  once,  but  not  more  than  once  ; 
and,  by  a  strange  turn  of  casuistry,  were  allowed  to  amuse 
themselves  with  drawing  but  not  with  painting,  because 
painting  was  their  father's  work,  and  they  must  not  work  on 
Sunday. 

Victor's  earliest  letters,  from  1863  to  1868 — from  his  sixth 
year  to  his  eleventh — are  short,  objective,  and  abounding  in 
happiness.  They  show  a  quick  sense  of  the  beauty  of  the 
world,  but  are  neither  sentimental  nor  imaginative.  The 
spelling  is  remarkably  correct  :  it  may  have  been  controlled 
from  above.  One  or  two  of  the  letters  are  in  French  ;  and 
that  so  bad  that  it  may  have  been  intentional ;  but  opinions 
arc  divided  on  this  point.  It  is  recorded  of  him,  at  the  age  of 
six,  that  he  asked  his  governess  whether  a  chair  in  French 
were  still  feminine  if  a  man  sat  on  it. 

1863.  To  his  mother.  April  13.  I  hope  you  will  come  on 
my  birthday  and  bring  me  some  presents  from  London.  On 
Sunday  we  went  for  a  walk,  and  when  we  came  back  we  made 
an  r)ld  man  of  sand.  Grass  is  iiis  hair,  two  lapides  for  his 
eyes,  a  curled  piece  of  stick  for  his  nose,  and  a  straight  piece 
of  stick  for  his  mouth.  I  am  going  to  draw  hunting  a  tiger. 
April  16.  I  think  you  will  be  glad  to  hear  that  my  cold  is 
better.  I  had  some  sugar  and  a  baked  apple  last  night.  I 
have  two  mountain  ashes,  some  beans  and  peas  in  my  garden. 
April  28.     It  is  very  stormy  to-day,  and  I  think  there  will  be 


FROM  1857  TO  1873  9 

lightning.  This  morning  I  gathered  a  very  large  violet.  We 
have  a  great  many  beans  which  Jenner  gave  us.  I  want  to 
put  affectionate  now.  1866.  To  his  mother.  May  i.  I  hope 
that  you  have  arrived  in  London  safely  with  no  accident  at 
all.  I  have  done  all  that  I  have  to  do  this  evening,  and, 
having  some  spare  time,  I  tliought  I  would  write  to  you. 
You  know  the  side  which  I  had  my  swell  face,  well,  on  the 
opposite  side  I  have  a  gumboil. 

1867.  To  his  father.  April  j.  How  are  you  ?  Have  you 
been  to  the  Academy  ?  Did  you  get  my  letter  yesterday  ? 
Do  you  know  it  is  only  four  days  to  the  holidays  ?  We  went 
to  Admiral  Houston's  yesterday.  Near  their  garden  (at  least 
it  is  joined  to  it)  is  a  little  wood  full  of  Httle  paths.  The 
ground  there  is  carpeted  with  primroses,  anemones,  blue, 
white,  and  purple  periwinkles,  besides  some  red  primroses.  I 
think  it  must  have  been  a  garden  once,  but  now  it  is  all 
shrubs,  moss,  young  and  old  trees.  At  the  bottom  of  this 
little  road  there  is  a  stream.  Will  you  ask  Grandmamma  for 
some  seeds  ?  May  21.  How  are  you  ?  Is  the  Exhibition  a 
nice  one,  and  are  there  many  pictures  ?  It  has  been  very 
rainy  to-day  except  this  evening.  There  is  a  beautiful  sun- 
set, it  seems  quite  to  gild  the  dining-room.  Oct.  30.  Have 
you  arrived  at  London  safely  ?  How  many  students  had  you 
to  teach  to-night  ?  Did  you  have  more  than  30  or  40  ? 
How  old  are  some  of  them  ?  Are  there  any  about  20  there  ? 
because  I  want  to  know.  Nov.  7.  On  Monday  night  w^e 
had  a  dozen  squibs,  12  blue  hghts,  12  crackers,  3  Roman 
candles,  and  18  Catherine  wheels.  We  invited  Mr.  Garden, 
the  two  girls,  and  Freddy.  I  bought  a  dormouse  to-day 
for  a  shilling,  witli  a  cage  too,  from  a  schoolboy,  he  is  called 
Louis  Broome.  It  was  not  his,  it  was  the  eldest  Yates,  but 
he  owed  Broome  a  little  more  than  a  shilling,  so  I  was  to 
give  it  to  Broome.  Walter  is  making  a  bowsprit  and  mast  to 
the  boat  Mr.  Paine  made  for  us.  He  made  the  body  for  us, 
not  what  Walter  is  making  this  evening.  Have  you  gone  to 
the  students  this  week  ?  What  sort  of  model  was  it  ?  Was 
it  the  same  one  that  was  there  last  week  ?  How  are  you  ? 
Will  you  ask  Aunt  Sophy  if  she  has  any  stamps  for  us.  An 
answer  is  requested.  Dec.  15.  I  have  fmislicd  tlio  drawing 
for  Mama  on  Christmas.  We  have  been  examined  in  Enghsh 
and  Roman  History,  in  Geography,  and  Greek.  We  are  going 
to  begin  Bible  Examination  to-morrow.  We  begin  our  holi- 
days on  Thursday.  .  .  .  Did  you  hear  the  Fenian  explosion  ? 
I  will  draw  you  a  picture. 

1868.  To  his  father.  Front  Broadstairs.  Mon  cher  Papa 
Joliannes.  We  have  bathed  twice  and  are  learning  to  swim. 
The  man  is  a  jolly  old  fellow,  there  is  a  nice  hfcboat  and  jetty, 
and  there  is  a  beautiful  little  boat.  Sept.  4.  From  Ramsi^ate. 
We  went  to  Pcgwell  to-day  and  they  were  firing  off  the 


lo  SIR  VICTOR  HORSLEY 

cannons  at  a  target,  I  liked  it  very  much.  You  could  hear 
the  ball  as  it  went  along.  They  made  some  ver>'  good  hits, 
one  went  clean  through  the  canvas  twice  while  we  were 
there,  and  knocked  away  the  right  pole.  This  is  where  they 
fired  from  :  the  Range  was  a  thousand  yards.     We  stood  at  A. 

The  children  had  good  friends  of  their  own  age,  in  or  near 
Cranbrook  :  the  sons  of  F.  D.  Hardy,  the  artist ;  and  the 
O'Neills,  cousins  and  near  neighbours  ;  and  the  Vizards 
at  Sissinghurst,  a  large  family,  the  girls  all  set  on  earning 
their  own  living  ;  one  of  them,  in  1873,  was  governess  at 
Willesley,  The  liberties  of  Sissinghurst  were  an  escape  from 
the  restraints  of  W'illesley,  and  the  Horsley  boys  used  to 
go  there  on  Saturday  half-holidays.  Mrs.  Carter  (Miss 
Jessie  Vizard)  remembers  them  well.  It  seems  that  Walter 
was  her  favourite  :  Gerald  used  to  offer  his  heart  and  hand 
in  fantastical  style  to  each  of  the  young  ladies  in  turn  : 
Victor  was  full  of  fun,  laughing  and  skylarking,  with  little 
fugitive  moods  of  quietness.  A  letter  from  him  to  her,  when 
he  was  thirteen,  and  she  was  teaching  some  children  in 
London,  contains  a  very  good  sketch  of  her  and  them 
groping  their  way  through  a  London  fog.  Her  sister,  Mrs. 
Hubbard,  writes  : 

I  knew  Victor,  first  of  all,  when  I  was  seven  and  he  was 
nine  years  old  :  we  were  tremendous  friends  in  those  days. 
He  and  I  used  to  go  about  together,  getting  rabbits'  food, 
hiding  together  in  our  many  games  of  hide-and-seek,  and 
generally  contriving  to  do  things  together.  Later,  we  used 
only  to  meet  in  the  summer  hohdays,  and  then  I  connect 
him  with  teaching  us  tennis,  but  chiefly  with  a  game  which 
we  invented,  all  of  us,  called  '  ghosts '  :  a  most  blood- 
curdling form  of  hide-and-seek,  to  be  played  in  the  evening, 
preferably  by  moonlight. 

But  Victor's  chief  delight  at  Willesley  was  in  the  skittle- 
alley  which  Mr.  Horsley  had  added  to  the  house.  The  boys 
played  the  nobler  form  of  the  game,  throwing  the  discus, 
the  big  wooden  '  cheese.'  Victor's  highest  score  may  still 
be  seen  on  the  wall,  and  the  black  cat  which  he  painted  as  a 
target  for  pistol-practice.  He  would  swing  from  a  horizontal 
bar  by  one  hand,  and  fire  with  the  other  ;  not  without  some 
danger  to  his  httle  sister,  Rosamund.     She  writes  of  him  : 


VICTOR     HORSLEY. 
At  the   Age   of    Eleven. 


FROM  1857  TO  1873  Ti 

I  wonder  how  old  he  was  when  this,  which  I  have  heard 
my  father  relate,  happened.  They  were  riding  together,  he 
on  a  small  pony  by  the  side  of  my  father's  big  mare  ;  and 
my  father  asked  him  what  he  would  like  to  be  when  he  grew 
up.  '  A  cavalry  ofificer,'  he  said.  '  No,  my  boy,  I  couldn't 
afford  that  :  how  would  you  like  to  be  a  doctor  ?  '  '  Oh,  all 
right  :  plenty  of  riding  and  driving  and  cutting  about.'  I 
think  that  this  was  very  indicative  of  his  then  state  of  mind, 
for  he  was  a  t}'pical  country  boy  :  not  particularly  brilliant 
at  school,  keen  on  birds'-nesting  and  bathing  and  adventures 
in  woods  and  fields,  always  in  scrapes  at  home  and  abroad, 
trespassing  after  birds'  eggs  and  fleeing  from  gamekeepers  : 
wrapped  up  in  his  silkworms  and  dormice,  and  in  the  little 
mechanical  devices  connected  with  them. 

Later,  the  subject  was  naturally  resumed.  On  this  occa- 
sion he  said  that  he  would  be  an  artillery  officer,  and  was 
again  told  that  it  could  not  be  afforded.  He  then  said  that 
he  would  be  a  doctor,  on  this  condition,  that  he  should  be  a 
surgeon,  not  a  physician.  My  father  accepted  this  de- 
cision, and  promised  him  a  set  of  scalpels  for  a  birthday 
present. 

We  Uved  only  half  a  mile  from  Cranbrook,  with  its  EUza- 
bethan  grammar-school,  where  the  boys  went,  and  my 
impression  is  that  Victor  was  in  almost  perennial  hot  water. 
Once,  at  the  midday  meal,  my  father  had  been  reading  him 
a  long  and  serious  lecture  on  the  enormity  of  his  conduct  in 
general,  with  special  reference  to  his  destructive  proclivities, 
to  which  he  listened  respectfully — probably  at  the  same  time 
bending  back,  under  the  tablecloth,  the  prongs  of  a  fork,  to 
see  how  far  they  would  go  without  snapping.  Then  suddenly 
he  said  clieerfuUy,  '  All  right,  I  '11  try  to  remember,  but  I 
must  be  off  to  scliool  now  ' — jumped  up,  caught  his  foot  in 
the  tablecloth,  and  dragged  half  the  glass  and  china  to  the 
floor.  My  fatlicr  sank  back  in  his  chair,  arms  thrown 
aloft  in  half-humorous  anger.  It  was  a  good  iUustration  of 
what  he  was  often  saying,  '  The  essence  of  mischief  is  bottled 
in  a  boy.' 

Victor  was  always  daring,  rather  reckless,  and  full  of 
courage.  I  remember  sitting  with  my  mother  one  after- 
noon, and  he  came  into  the  room,  from  playing  hockey,  with 
his  face  covered  with  blood  and  one  eye  apparently  destroyed. 
'  Can  you  see  anything  in  my  eye  ?  '  was  his  characterislic 
question. 

I  think  that,  so  soon  as  he  made  uj)  his  mind,  in  consequence 
of  my  father's  suggestion,  to  be  a  medical  man,  he  started 
investigating  tiie  interiors  of  birds  and  animals,  for  I  was 
very  early  fascinated  by  watching  the  dissection  of  a 
starling  on  the  table  in  tlic  summer-house,  and  later  of 
a  mole. 


12  SIR  VICTOR  HORSLEY 

After  all,  there  is  nothing  unusual  in  a  boy  making  up  his 
mind  to  be  a  doctor.  Besides,  the  family  was  closely 
associated  with  the  profession.  Haden  of  Derby,  Charles 
Hadcn,  Seymour  Haden,  and  Scth  Thompson,  all  belonged 
to  it;  and  the  adventures  of  another  member  of  the  family, 
Isambard  Brunei — not  as  a  surgeon,  but  as  a  surgical 
patient — had  been  talked  of  far  and  wide.  He  had  been 
conjuring  with  a  half-sovereign,  pretending  to  swallow  it, 
and  it  had  shpped  into  his  air  passages  :  he  had  undergone 
tracheotomy,  had  devised  a  revolving  table  on  which  he 
could  be  suddenly  turned  head  downward,  and  after  many 
days  had  coughed  up  the  coin.  With  these  associations,  it 
was  natural  that  Mr.  Horsley  should  think  of  having  a  son 
in  the  medical  profession.  It  was  no  less  natural  that 
Victor's  first  thoughts  should  be  of  the  Army.  Walter  and 
he  were  always  drawing  pictures  of  soldiers  in  action.  The 
children  were  allowed  any  amount  of  pencils  and  paper ; 
and  Walter's  early  battle  pieces  are  admirable.  Later,  they 
joined  the  Volunteers,  and  worked  hard  in  that  nationa 
service.  Failing  the  Army,  Victor  was  willing  to  be  a 
surgeon.  At  the  most,  he  was  not  more  than  fifteen  when 
he  made  his  choice  :  for  his  father  writes,  in  September 
1872,  '  Vic  has  to  attend  a  class  from  two  to  three,  arranged 
on  half-holidays  especially  for  those  with  Victor's  future 
views.'  He  found,  among  his  father's  books  at  Willesley, 
Albinus's  Anatomy;  and  the  plates  were  of  great  interest 
to  him. 

By  June  1873,  he  started  to  work  with  the  microscope. 
There  is  a  letter  to  his  mother,  June  22,  1873,  in  French, 
more  or  less  wilfully  bad  :  no  boy  of  sixteen  could  write 
such  French  with  perfect  seriousness.  The  letter  recalls 
exactly  the  beginning  of  microscope  work  in  those  days  : 

J'espere  que  vous  etes  tres  bien  (ou  avez  belle  sant^). 
Vous  savez  que  les  livres  do  Mr.  Macaulay  etaient  10  francs, 
et  que  j'eu  dans  la  Bourse  vingt  ct  cinq  francs.  Je  va  a 
Mr.  Clarke's  Samcdi  le  21""'  et  il  me  donne  du  thi  et  me 
pret^  un  livre  de  la  preparation  des  objets  pour  le  microscope. 
Mr.  Clarke  dit  qu'il  suit  necessaire  que  je  I'achete.  Je  veux 
que  Gualtier  aille  k  Mr.  Raker  No.  244  High  Holbom  quand 
il  lui  plait  et  achctd  ces  articles  suivantes. 


FROM  1857  TO  1873  13 

I  oz.  de  '  mixed  '  circular  thin  covering  glasses. 
12  slides,  rough  edges. 

Une  petite  bouteille  du  '  Canada  balsam.' 

Une  ditto  de  gold  size. 

Une  ditto  d'Asphalte. 

Trois  tubes  de  verre. 

Une  petite  syringe. 

24  ivory  rings  (comme  on  dit)  des  '  mixed  '  sizes. 

II  ne  sera  plus  que  dix  francs  s'il  est  tantot,  avec  le  prix  de 
livre  qui  est  2s.  6d.  (On  Preparing  and  Mounting  Micro- 
scopic Objects,  bv  T.  Davies.  Published  by  R.  Hardwicke, 
192  Piccadilly.)  Mr.  Baker  est  le  plus  '  cheap  '  et  le  meilleur, 
comme  Mr.  Clarke  dit. 

La  coste  des  livres  de  Macaulay  subtracte  de  la  monnaie 
dans  la  Bourse  will  leave  15  francs.  Si  la  coste  des  articles 
nomm^s  n'est  pas  egal  a  ce  prix  (15  francs)  je  veux  que  le 
remainder  be  sent,  car  il  faut  que  j'ai  fit  une  table  de  verre 
(turn-table)  que  Mr.  Clarke  dit  etre  indespensable.  Avec 
mes  plus  meilleurs  regards  a  tons,  Je  ramener  votre  plus 
affectionate  fils  Victor  A.  H.  Horsley.  J'ecri  cette  lettre 
avec  le  main  courant. 


In  December  1873,  he  left  Cranbrook  School :  he  had  been 
there  since  1866.  In  Victor's  time,  it  had  passed  through  a 
period  of  depression,  and  was  going  up  rapidly  in  numbers, 
under  its  new  head  master,  Dr.  Crowden  :  who  remembers 
Victor,  in  1866,  as  a  '  small  chubby-faced  boy,  who  on  wet 
days  came  to  school  with  his  brother  Walter  in  a  covered 
donkey-cart.  He  was  not  greatly  distinguished  in  his 
school  work,  but  he  obtained  his  moves  from  form  to  form 
with  creditable  regularity.'  The  new  school  buildings  are 
later  than  Victor's  time  :  the  present  '  Big  School '  was 
built  in  1884-85  :  the  old  '  Big  School '  is  now  the  School 
Chapel  :  it  used  to  be  curtained  off  into  classrooms,  and  Dr. 
Crowden  used  to  take  the  sixth  form,  at  the  upper  end  of  the 
room.  A  narrow  wooden  staircase  leads  up  to  it  from  the 
old  playground,  and  on  this  staircase  Victor  had  a  fight  with 
one  of  the  older  boys,  who  was  bullying  a  new  boy.  In 
1866,  there  were  only  forty  boys.  He  of  course  was  a  day 
boy,  and  went  home  for  the  midday  meal.  He  had  not  the 
present  advantages  of  Cranbrook — the  new  buildings,  the 
armoury  for  the  cadet  corps,  the  laboratories  and  lecture 
room  for  chemistry  and  physics.     But  he  had  the  coiuitry- 


14  SIR  VICTOR  HORSLEY 

side  for  a  playground,  and  the  skittle-alley  for  a  gymnasium, 
and  the  rifle  butts  for  an  armoury ;  and  he  could  afford  to 
wait  for  a  laboratory. 

He  was  in  the  sixth  form  on  the  classical  side  when  he  left 
the  school.  He  had  gained  some  prizes,  in  classics,  in  draw- 
ing, even  in  French  :  these  last  might  well  have  been  be- 
stowed elsewhere.  He  was  fond  enough  of  the  school  games, 
but  was  not  very  skilful  at  them  :  he  greatly  enio\'ed  fooiball 
and  hockey,  but  cared  little  for  cricket.  Greek  and  Latin, 
as  languages,  never  got  much  of  a  hold  on  him  :  but  his 
reading  of  the  classics  helped  him  toward  that  love  of 
archaeology  which  was  so  strong  in  him  all  his  life.  But 
Cranbrook  made  no  deep  impression  on  him,  nor  he  on 
Cranbrook.  He  ought  to  have  gone  to  some  great  public 
school  far  from  home.  The  day  boy's  life,  the  monotony 
of  the  half-mile  four  times  in  every  twelve  hours,  the  same 
setting  of  his  work  and  play,  year  in  year  out — these  were 
not  good  enough  for  him  :  he  needed  to  be  sent  right  away, 
into  wider  experiences  and  statelier  traditions,  under  such 
discipUne  as  neither  Cranbrook  nor  Willesley  could  give  him. 
He  came  near  to  having  this  advantage,  but  never  had  it. 
There  is  a  letter  from  his  father  to  his  mother,  August  25, 
1872,  saying  that  '  the  fever,'  i.e.  scarlet  fever,  had  broken 
out  again  in  the  little  towTi  : 

This  brings  me  to  another  important  consideration  that  has 
been  simmering  in  my  mind,  for  some  days,  about  Victor.  I 
don't  at  all  like  the  idea  of  his  living  anywhere  in  our  filthy 
town.  I  think  the  school  has  done  very  well  up  to  the 
present  time,  but  I  think  we  might  do  better  for  Vic.  for  the 
next  year  and  a  half,  by  sending  him  as  boarder  (which  he 
must  be  wherever  he  goes  when  we  are  away)  to  such  a  school 
as  Charter  House.  We  know  that  it  is  now  in  a  splendidly 
healthy  position,  newly  built  with  every  modern  appliance. 
I  know  liaig  Brown,  the  Head  Master,  and  Vic  would  have 
his  friend  Daldy  to  introduce  him.  Moreover  a  year  or  two 
at  such  a  good  public  school  might  be  of  much  service  to 
him.  .  .  .  Think  of  this.  I  would  write  and  find  all  particu- 
lars as  to  cost,  etc.  As  long  as  that  town  of  Cranbrook 
remains  as  it  is,  undrained  and  with  such  a  bad  water  supply 
or  supply  of  bad  water,  I  should  never  be  easy  to  have  any 
one  I  cared  for  in  it.  Daldy,  having  done  so  well  and  being 
so  good  a  mathematician,  might  be  a  great  help  to  Vic. 


II 

From  January  1874  to  September  1878 

In  January  1874  he  matriculated  at  the  University  of 
London  :  he  was  prepared  for  examination  by  Mr.  (Sir 
Philip)  Magnus.  After  it,  he  set  to  work  for  his  prehminary 
scientific  examination,  attending  lectures  at  University 
College,  and  reading  at  home,  and  \\'ith  Mr.  Magnus  :  two 
other  students,  William  Pasteur,  now  Senior  Physician  to 
the  Middlesex  Hospital,  and  Alfred  Lendon  of  Adelaide, 
were  his  fellow  pupils.  Dr.  Lendon  remembers  him  well  at 
this  time,  a  tall,  manly  youth,  with  a  very  delightful  smile  : 

He  had  a  strong  sense  of  humour,  which  was  very  congenial, 
for  we  were  both  staunch  admirers  of  Dickens  :  he  was  over- 
flowing with  the  joie  de  vivre  :  he  had  been  brought  up  to 
enjoy  country'  life.  In  conversation,  he  was  inclined  to  be 
assertive  and  disputatious  :  '  Oh  rot  !  '  was  a  very  favourite 
expression  :  he  was  always  distinctly  dogmatic  in  his  views  : 
if  sarcastic  at  times,  there  was  no  venom  introduced  ^vith  the 
sarcasm.  His  way  home  from  Mr.  Magnus's  house  passed  my 
way  :  he  walked  with  a  long  stride,  and  it  was  rather  an 
effort  for  me  to  keep  up  with  him. 

Sir  Oliver  Lodge,  who  in  1874  was  an  assistant  teacher  at 
University  College,  writes  of  him  : 

It  is  very  surprising  that  I  remember  him  so  well  as  a 
student,  but  I  do.  although  he  was  only  studying  Physics  for 
one  year  in  the  usual  fasliion  prescribed  for  a  Medical  Uni- 
versity Course.  But  he  made  an  impression  on  me  from  the 
first.  I  remember  even  wlicrc  he  used  to  sit,  in  tlic  front 
row  on  the  left-hand  side  of  the  lecture  table  in  tlie  old 
Physics  Theatre  above  the  Botanical  Tlicatre  at  University 
College.  He  and  another  man,  whose  name  I  do  not  re- 
member, used  to  sit  togetlier,  and  were  easily  first  in  marked 
ability.  For  though  the  Course  was  only  the  Junior  Physics 
appropriate  to  the  Prel.  Sci.  M.B.,  yet  I  perceived  that  he 

16 


16  SIR  VICTOR  HORSLEY 

wa3  one  of  those  men  who  would  do,  in  a  first-class  manner, 
whatever  they  undertook. 

The  Course  was  not  mine,  it  was  given  by  Carey  Foster ; 
1  was  only  a  senior  student  employed  by  him  to  correct  the 
exercises  and  to  go  about  among  the  students  helping  them 
to  do  their  problems  or  criticising  the  way  in  which  they  were 
done.  Consequently  I  saw  more  of  the  individual  men  than 
if  I  had  been  the  Lecturer. 

I  was  the  Lecturer  in  later  years,  but  not  in  1873-75,  and 
it  was  in  one  of  the  quite  early  3'ears  (probably  in  1874)  that 
I  first  remember  Horsley.  I  cannot  tell  you  anything  in 
detail  about  him,  but  the  fact  remains  that  no  student  at  that 
period  made  so  distinct  an  impression  on  me,  and  when  he 
came  out  as  a  brilliant  surgeon  later  on,  it  was  with  pleasure 
that  I  remembered  my  first  acquaintance  with  him. 

In  holiday  time  at  Willesley,  in  and  after  1874,  he  worked 
with  Dr.  Joyce  of  Cranbrook  ;  it  was  pleasant,  informal, 
discursive  work,  and  it  gave  him  his  first  insight  into 
general  practice.     Dr.  Joyce  writes  : 

He  worked  with  me  for  a  few  months  after  leaving  Cran- 
brook School :  we  chiefly  did  microscopic  and  biological  work. 
I  still  have  some  slides  which  he  put  up  :  one  is  a  section  of 
the  parietal  bone  of  a  stag,  another  is  a  section  of  fossil  wood 
from  Kentish  ragstone,  which  he  ground  downi.  .  .  .  When 
we  had  nothing  better  to  do,  we  used  to  amuse  ourselves  by 
overhauling  the  dumps  of  Kentish  ragstone  at  the  roadside, 
in  search  of  fossils,  and  one  day,  to  his  great  delight,  we  came 
across  a  nest  of  oyster-spat :  the  tiny  oysters  were  about 
one-eighth  inch  across  :  he  carted  them  off  for  the  museum 
which  he  was  then  beginning  to  form.  The  last  work  I  recol- 
lect his  doing  with  me  before  he  began  practice  in  London, 
was  on  a  poisoning  case  :  a  woman  had  given  her  husband 
and  her  child  something  that  she  thought  was  yellow  sulphur  : 
both  died,  and  I  had  cliarge  of  the  case.  He  rigged  up  a 
Marsh's  apparatus,  and  got  a  deposit  of  metallic  arsenic  from 
the  contents  of  the  man's  stomach.  We  found  out  after- 
wards that  he  had  been  given  a  dose  of  Cooper's  sheep-dip. 

In  July  1875,  he  passed  his  preliminary  scientific  ex- 
amination, and  got  a  College  gold  medal  for  anatomy. 
His  father's  letters  to  his  mother  recall  the  worship  of 
examinations  at  that  time  : 

/«/v  22.  I  am  very  sorrv  I  forgot  to  leave  a  message  for 
Victor  to  tell  him  to  write  to  me,  as  last  night,  about  his  day's 


JAN.  1874— SEPT.  1878  17 

work.  Tell  him  how  much  I  think  of  him  and  how  very 
frequently  I  have  prayed  to  God  that  his  industry  of  the 
past  year  may  be  rewarded  with  success.  At  the  same  time 
I  am  quite  prepared  to  know  that  he  has  not  succeeded,  and 
that  the  work  has  been  too  much  for  the  time  in  which  he 
has  had  to  do  it.  I  trust  he  has  remembered  to  pray  for 
strength  in  this  and  in  all  his  work.  July  23.  I  was  much 
disappointed  that  you  did  not  mention  how  Victor  had  got 
on  on  Wednesday.  Tell  me  all  about  his  work,  and  what 
his  impression  is  as  to  the  result.  July  25.  I  dreamt  last 
night  that  I  went  to  inquire,  and  saw  a  hst  in  which  V.'s 
name  was  not :  however,  a  porter  came  forward  and  said 
that  was  not  the  hst  in  which  he  would  appear,  and  that  it 
would  not  be  out  for  a  week  !  July  31.  You  '11  have  got 
Vic's  telegram,  I  trust,  and  will,  I  am  sure,  be  as  thankful  as 
I  am  at  his  success.  To  have  passed  his  PreUminary  Sci. 
1st  division  and  got  the  medal  too  is  a  great  achievement.  .  .  . 
I  gave  V.  a  sovereign  for  the  medal,  and  now  I  've  given 
him  another.  I  thought  at  one  time  of  a  '  fiver,'  but  perhaps 
I  have  done  enough.  Aug.  i.  Victor  got  his  medal  to-day, 
a  very  pretty  one,  \vith  his  name  engraved,  and  a  good- 
looking  testimonial  to  his  diligence  and  industry,  etc.,  signed 
by  Lords  Belper  and  Kimberley  and  Professor  Allchin.  I 
have  put  it  in  the  iron  safe,  and  the  medal  shall  go 
there  aJso. 

The  ne.xt  three  years,  from  October  1875  to  July  1878, 
were  given  to  anatomy  and  physiology.  He  took  his  time 
over  them  :  he  had  Ellis  and  Thane,  Burdon  Sanderson 
and  Schafer,  for  his  teachers  :  he  could  not  wish  for  any- 
thing better.     His  father  writes,  November  17,  1875  : 

Vic  and  I  were  at  breakfast  before  8,  and  he  was  off 
before  8.15.  He  is  deeply  interested  in  his  '  part  '  [entre 
nous  a  bit  of  an  old  'ooman),  and  from  what  I  sec  and  hear, 
nothing  could  be  more  satisfactory  than  liis  proceedings.  I 
find  from  Morton  that  he  dines  when  he  comes  home  about 
2.30,  and  then  goes  and  dines  again  most  days  with  tlie 
William  Callcotts,  at  7,  which,  as  Morton  says,  docs  for 
tea  and  supper  !  !  He  won't  starve  I  She  says  he  is  always 
home  by  8.30.  He  feels  now  that  any  one  with  him  would 
be  in  his  way,  as  he  works  every  evening. 

And  Victor,  in  a  letter  of  the  same  month,  says,  '  It  is 
quite  necessary  that  I  should  work  till  it  p  ^t.  now,  especially 
as  eight  hours'  sleep  is  oceans.' 

B 


18  SIR  VICTOR  HORSLEY 

Dr.  Lendon,  who  was  just  senior  to  him  at  University 
College,  writes  : 

I  remember,  about  the  time  when  he  first  made  his  ap- 
pearance in  the  dissecting-room,  demonstrating  to  him  with 
chalk,  and  with  the  seat  of  a  wooden  stool  for  a  blackboard, 
the  intricacies  of  the  brachial  plexus,  and  I  can  even  recall 
the  pleased  look  he  gave  me. 

For  three  sessions,  from  1875  to  1878,  he  attended  the 
lectures  in  anatomy  and  in  physiology :  his  notes  of 
Burdon  Sanderson's  lectures  are  a  model  of  careful  note 
taking.  In  the  Students'  Medical  Society,  he  read  a  paper, 
in  the  winter  session  of  1875-76,  '  On  the  ending  of  the 
tendons  in  the  rat's  tail,'  and  a  paper,  in  the  winter 
session  of  1876-77,  '  On  the  terminations  of  muscular  fibres  ; 
and  a  note  on  the  structure  of  intervertebral  discs.'  The 
first  paper  is  lost ;  the  second  paper  is  a  long  and  carefully 
written  record  of  good  original  microscope  work,  such  as 
few  students  were  doing  at  that  time  ;  and  in  1877,  the 
Students'  Society  gave  him  a  prize  of  £5  for  it,  and  put  him 
at  the  head  of  the  list  of  students  elected  to  be  its  officers. 
At  the  end  of  the  summer  session,  1877,  in  the  College 
examination  in  physiology,  Bilton  Pollard  got  the  gold 
medal,  and  Francis  Gotch  and  Horsley  and  Rushton  Parker 
were  tied  for  the  silver  medal :  in  the  examination  in 
practical  physiology — section  cutting,  chemical  testing, 
etc. — W.  H.  Neale  got  the  gold  medal,  and  Horsley  the 
silver  medal.  Then  came  the  great  event  of  1877,  a  month's 
holiday,  with  J.  F.  \V.  Silk,  in  Germany.  His  diary  of  this 
tour,  a  hundred  and  twenty  closely  written  pages,  has  come 
to  hand  :  doubtless  it  was  required  of  him  by  his  father  : 
its  tone  is  none  the  less,  or  all  the  more,  independent.  The 
young  men  went  by  Queenboro'  and  Flushing,  up  the  Rhine, 
and  from  one  German  town  to  another,  now  by  rail,  now 
sending  their  bags  ahead  and  walking  with  knapsacks.  They 
saw  what  they  could  of  universities  and  museums  and 
laboratories,  with  the  help  of  a  card  of  introduction  from 
Burdon  Sanderson  ;  it  is  stuck  in  the  cover  of  the  diary  as 
'  our  passport.'  They  made  the  most  of  their  time,  rising 
at  6.30,  river  bathing,  sight  seeing,  tramping.     The  diary 


JAN.  1874— SEPT.  1878  19 

is  the  very  image  of  him.  The  fastidiousness,  the  extra- 
vagantly worded  condemnation  of  all  offending  persons, 
institutions,  or  works  of  art,  the  perfect  self-sufficiency — 
in  the  good  Greek  sense  of  the  word — these  all  playing  on 
the  surface  of  his  life.  He  had  to  be  saving  of  money  : 
his  expenses,  all  the  way  to  Wiirzburg  and  back — from 
August  4  to  September  2 — were  j^i8.  los.  8d. 

Flushing  —  the  Dutch  Army:  'The  soldiers  were  most 
absurd  and  apparently  were  innocent  of  any  discipline  what- 
ever. They  were  )'oung,  and  as  stupid-looking  as  possible. 
We  saw  a  company  being  marched  to  breakfast.  The  officers 
were  pretty  smart,  but  the  men  like  convicts  :  they  are 
armed  with  the  Chasscpot  and  ordinary  bayonet.  ...  At 
Bergen-op-Zoom  some  of  the  troops  were  encamped  in  bell 
tents.  At  Rosendaal  were  several  Hussars,  who  were  decent, 
and  that  is  all.  Besides,  they  must  have  ridden  about 
14  or  15  stone.'  Cologne:  '  The  table  d'h6te  at  the  Victoria 
was  characterised  by  dead  silence,  and  the  awful  and  fatal 
haste  with  which  the  people  eat — the  most  awful  and  stupid 
lot  I  ever  saw.  .  .  .  The  soldiers,  of  course,  are  very  numer- 
ous. As  a  rule  they  are  short  and  very  young,  mere  boys 
most  of  them,  but  well  made.'  In  the  museum  :  '  The  pic- 
tures were,  as  a  rule,  hideous  Catholic  things,  and  the  Roman 
antiquities,  considering  the  importance  of  the  place,  were  but 
commonplace  things.'  A  Schiitzenfest  at  Deutz :  '  The 
greatest  jest  and  farce  of  the  wliole  was  the  prime  object,  the 
shooting.  The  men  had  blunderbuss  carbines,  rested  !  !  ! 
them  in  a  wooden  cupboard  affair,  and  fired  at  round  discs 
a  foot  broad  about  30  yards  from  this  cupboard  affair.' 
Table  d'hdte  again  :  '  There  was  a  swell  who  talked  sense, 
and  a  snob  who  talked  nonsense ;  the  latter,  by  the  way,  ex- 
pressed himself  strongly  anti-German,  so,  looking  at  his  brain, 
we  came  to  the  conclusion  that  argument  was  of  no  avail. 
He  became  excited  under  the  Nicdersteincr,  and  finally  spilt 
some  in  pouring  it  out,  saying,  "  I  like  this  wine."  I  could 
not  help  chuckling,  and  he  was  immediately  silent  and  con- 
tinued so  throughout.'  Bonn — the  University  :  '  A  long, 
straggling  line  of  buildings  :  it  is  awfully  ugly,  and  has  a 
gingerbread-looking  statue  in  front.'  The  Coblcntzer  Thor  : 
'  Over  which  was  another  gilt  affair  of  St.  George  assiduously 
tickling  a  bright  yellow  dragon,  who  had  evidently  given  up 
long  ago,  and  was  merely  expostulating.'  The  anatomical 
institute  and  museum  :  '  The  comparative  anatomy  skeletons 
were  good  and  orderly  in  arrangement  :  the  human  anatomy 
was  most  disorderly,  and  utterly  useless  for  any  systematic 
reading  or  even  demonstration.'     KcnigswitUtr  :  '  The  room 


20  SIR  VICTOR  HORSLEY 

we  were  in  was  nice  and  airy,  but  had  recently  been  varnished, 
so  that  if  we  remained  some  time  in  any  place  it  was  difficult 
to  "  tear  ourselves  away."  ' 

Coblentz — the  fortifications  of  Ehrenbrcitstein  and  the 
Karthause  :  '  The  Schutzplatz  was  very  absurd  :  they  fired 
in  long  ditches  with  the  target  at  the  end.  In  this  way  tliey 
avoided  all  difficulties  of  sun,  wind,  etc.,  but  lost  view  of  the 
fact  that  these  are  unavoidable.'  St.  Goar — the  Rlieinfels  : 
'  The  custodian  was  a  great  joke  :  he  talked  very  clearly,  so 
it  was  easy  for  us  to  understand  him  :  our  xdews  on  the 
Eastern  Question  coincided,  and  he  declaimed,  with  great 
vigour  that  both  the  Russians  and  Turks  were  pigs.'  Mainz — 
the  soldiery  :  '  Very  small  and  grubby-looking  :  the  Hussars 
are  the  best,  and  they  seem  to  ride  far  too  heavily.'  The 
museum  :  '  The  best  things  were  Romano-Frankish  graves, 
one  complete,  being  well  worth  the  visit.  The  collection  of 
implements,  too,  is  very  fine,  and  more  especially  the  Roman 
sandals  :  it  appears  that  they  came  on  a  find  of  them  in  the 
Emmenstrasse  :  they  certainly  are  very  perfect.  The  gold 
torques,  too,  were  very  magnificent.  But  one  would  see 
Greek,  Roman,  Frank,  and  mediaeval  helmets  on  the  same 
shelf.'  Frankfort — the  Romer  :  '  The  beggars  who  painted 
the  Kaisersaal  were  sweeps,  for  they  have  left  out  the  Earl 
of  Cornwall,  who  was  Emperor  for  twenty-two  years.' 
Heidelberg — the  hotel :  '  where  we  were  gorgeously  received 
by  half  a  dozen  waiters  and  the  landlord  into  the  bargain, 
who  was  such  a  nob  that  I  instinctively  took  off  my  hat, 
but  soon  put  it  on  again.'  The  physiological  laboratory,  with 
Ewald  ;  '  He  kindly  showed  us  the  vision  purple  :  one  sees 
a  beautiful  picture  of  the  retinal  elements  from  behind.' 
The  anatomical  museum :  some  rare  specimens ;  but  '  the 
museum  was  perhaps  in  the  most  disgraceful  and  unkempt 
condition  that  it  was  possible  to  be  in,  and  beyond  serving 
as  a  storehouse  for  a  demonstration,  it  was  of  no  use  what- 
ever. For  this  fraud  we  had  to  pay  half  a  mark  each  :  this 
is  the  case  with  all  these  museums,  and  it  certainly  reflects 
no  credit  on  the  scientific  guardians  :  it  seems  more  odd  from 
being  so  totally  unknown  in  England  and  so  utterly  unex- 
pected in  Germany.'  The  collection  of  duelling-swords : 
'  Really  one  would  think  the  men  would  have  a  httle  more 
common -sense  than  to  fool  about  in  this  extraordinary'  way, 
for  it  is  very  rarely  an  affair  of  honour,  and  as  the  students 
are  (so  far  as  we  have  seen)  quite  the  reverse  of  beautiful, 
they  cannot  spare  any  good  looks  to  be  disfigured.'  Stras- 
bourg— the  physiological  institute :  '  We  saw  Professors 
Goltz's  and  Hoppe-Seyler's  laboratories.  That  of  the  latter, 
except  his  private  room,  was  in  a  most  filthy  condition,  and 
how  they  could  get  trustworthy  results  is  a  mystery.  We 
saw  several  of  Goltz's  dogs,  which  were  very  interesting.' 


JAN.  1874— SEPT.  1878  21 

From  Appenweier.  a  thirty-four  miles  walk  to  Fremdenstadt : 
'  The  odours  of  all  kinds  that  came  through  the  house  were 
positively  starthng.  First  the  stables,  then  a  drain,  then 
coffee,  backed  up  by  the  cowshed.'  To  Stuttgart :  sixty-miles 
walk  in  two  days  :  '  A  good  museum  :  a  bad  service  at  the 
Enghsh  church.'  Ulm:  Augsburg:  a  day  at  Lech/eld,  for 
a  sight  of  the  Army  autumn  manceuvres. 

Munich — bags  not  arrived  :  '  Every  official  here  is  a  little 
king,  and  accustomed  to  lord  it.  Even  a  telegraph  fellow 
was  a  bumptious  httle  chap,  and  I  only  wished  I  knew 
enough  German  to  sarcasticise  him.  .  .  .  The  German  papers 
are  really  very  odd.  They  have  small  telegrams  containing 
hardly  any  news,  with  a  useless  article  on  the  war.  The 
remainder  of  the  paper  is  filled  with  advertisements  and  bosh, 
backed  up  by  a  novel :  the  latter  is  the  backbone  indeed  of 
the  paper.  The  gist  of  the  whole  matter  is,  of  course,  that 
they  are  so  fettered  by  the  Press  Laws.  Surely  this  over- 
government  cannot  last  long.  It  shows  itself  in  the  most 
extraordinary  ways.  .  .  .  The  interiors  of  the  pubhc  build- 
ings are  grand  and  fine,  but  the  exteriors  are  inexpressibly 
hideous,  prison-hke,  and,  moreover,  covered  with  the  extra- 
ordinary bilious  yellow-green  with  which  every  government 
building  is  painted.  How  an  artistic  city  could  perpetrate 
it  is  very  wonderful.'  The  museum  of  fossils  :  '  it  almost 
rivals  that  department  of  the  British  Museum  in  complete- 
ness and  beauty.  The  Solenhofen  quarries,  of  course,  have 
furnished  beautiful  invertebrates  especially.  This  museum 
should  be  studied  with  Owen.  Both  works  are  well  worthy 
of  each  other.' 

Finally,  Niiremberg,  where  he  was  properly  delighted  with 
the  treasures  of  art  in  the  churches  ;  and  was  plagued  with 
toothache — '  however,  managed  to  read  not  a  little  KoUiker, 
which  staved  it  off  somewhat ' — and  Wiirzburg,  where  he 
came  in  for  a  festival  in  honour  of  the  Crown  Prince,  who 
made  a  speech  to  the  people,  '  in  which  he  promised  to  tell 
the  Emperor  what  a  good  town  Wiirzburg  was.'  And  from 
Wiirzburg  home,  full  tilt  :  this  masterful  young  man  of 
twenty,  who  knew  his  own  mind,  and  could  exorcise  the 
toothache  by  reading  Kolliker's  Entwickclungsgeschichtc 
There  is  no  room  here  for  his  praises  of  the  beauty  of  the 
country',  his  delight  in  the  open-air  life. 

He  was  at  home  through  all  the  seven  years  of  his  time  as 
a  student  :  from  January  1874,  when  he  was  sixteen,  and 
began  reading  for  his  preliminary  scientific  exaiuinaticm,  to 


33  SIR  VICTOR  HORSLEY 

November  1880,  when  he  was  twenty-three,  and  passed  his 
qualifying  examination  at  the  Royal  College  of  Surgeons. 
These  all-important  years  refuse  to  be  cut  into  periods. 
The  events  of  them  are  plain  enough  :  but  there  is  more  than 
that  in  them.  He  was  kept  at  home  too  long  ;  he  ought  to 
have  had  his  freedom  before  1880,  before  the  influences  of 
home  and  the  influences  of  the  Hospital  were  in  final  conflict 
over  him. 

Mrs.  Gotch  has  written  of  these  years  at  home : 

No  sooner  did  he  really  take  up  the  study  of  medicine 
than  everything  gave  place  to  it.  He  was  a  bom  enthusiast. 
He  gave  up  everj-thing  which  would  interfere  with  his  work, 
though  to  the  last  his  boyish  love  of  fun  and  games  and  the 
country  was  as  keen  as  when  he  was  fourteen.  But  these 
things  were  only  recreations  :  work  came  first.  For  instance, 
he  was  fond,  as  a  boy,  of  dancing,  and  I  have  a  vision  of  him 
waltzing  at  a  party  in  our  big  dining-room  at  VVillesley, 
almost  lost  in  the  folds  of  the  dress  of  the  very  large  and 
stout  wife  of  the  country  solicitor  ;  but  I  don't  think  he  ever 
went  to  a  dance  after  he  came  to  London,  though  his  more 
frivolous  brothers  and  sisters  earned  for  themselves  the  title 
of  the  Dancing  Dervishes.  All  theatres  were  given  up  for 
some  years,  at  the  same  time.  Partly,  he  felt  that  theatre- 
going  was  against  his  duty  to  his  work  ;  partly,  there  was  a 
touch  of  the  puritan  spirit — he  did  not  hold  with  the  theatrical 
world,  he  thought  it  somehow  wrong. 

He  was  always  kind  to  me,  his  much  younger  sister,  and 
delighted  to  teach  me  odds  and  ends  of  zoology  and  anatomy, 
for  I  had  been  interested  in  these  subjects  from  the  time  of 
the  early  dissections  at  Willesley.  With  his  early  days  at 
University  College,  when  he  was  working  for  the  preliminary 
scientific,  began  a  system  of  Sunday  afternoon  walks  in 
Kensington  Gardens,  where  we  would  sit  on  a  bench  and  he 
would  illustrate  his  descriptions  of  amoebae  and  ciUated 
organisms  with  elaborate  drawings  on  the  sandy  gravel.  As 
he  got  on  to  anatomy  proper,  he  would  sometimes  bring 
home  small  '  parts,'  of  the  dissection  of  which  I  was  always 
the  privileged  spectator,  and  he  would  teach  and  explain, 
with  that  patience  and  enthusiasm  which  characterised  him 
all  his  life. 

Another  thing  which  he  liked  to  teach  me,  and  which  I 
loved  to  learn,  was  physical  exercises.  For  many  years  he 
was  a  devoted  member  of  the  Artists'  Corps,  which  he  only 
gave  up  because  of  its  interference  with  his  professional 
work,  and  for  hours  we  used  to  go  through  the  bayonet 
exercise,   or  singlestick  movements,  he  with  a  huge  old 


JAN.  1874— SEPT.  1878  23 

Snider,  I  with  some  counterfeit  weapon  of  a  lighter  nature  : 
or  we  would  stand  solemnly  opposite  each  other  bending  first 
one  knee  and  then  the  other,  to  strengthen  the  muscles  of  the 
thighs,  and  see  how  long  we  could  keep  it  up. 

He  dehghted  in  long  walks.  It  is  on  record  that  when  he 
was  not  more  than  fourteen,  he  and  his  friend  Lewis  Hardy 
walked  from  Willesley  to  Pevensey,  thence  by  train  to 
Hastings,  and  so  to  Etchingham,  and  walked  home  from 
Etchingham,  9  miles,  in  the  dark.  Altogether,  a  40-miles' 
walk.  Lunch  was  eaten  under  a  hedge  before  they  reached 
Pevensey.  On  another  occasion,  in  the  earlier  years  in 
London,  the  brothers  walked  to  Windsor,  22  miles,  in  snow 
and  sUppery  frozen  slush,  and  that  same  year,  on  Good 
Friday,  they  walked  to  St.  Albans  and  back,  and  saw  the 
Cathedral  as  well,  45  miles.  He  was  not  a  good  rider  :  he 
was  clumsy  at  some  things :  impetuosity  was  his  chief 
characteristic. 

It  was  after  we  came  to  live  in  London  that  he  learned  to 
love  the  river,  for  in  Kent  there  was  no  water  worth  speaking- 
of  uithin  our  reach.  Almost  the  first  time  that  I  remember 
going  on  the  river  was  at  Weybridge,  where  we  were  staying 
about  1877.  He  hired  a  boat  to  take  my  sister  and  me  out, 
and  we  were  very  much  appalled  when  my  mother,  who  had 
a  horror  of  the  water,  insisted  on  coming  too,  so  as  to  look 
after  us.  But  her  nerves  got  the  better  of  her  maternal 
feelings,  and  she  was  put  ashore,  happily  before  the  following 
incident  occurred,  and  I  need  hardly  say  that  she  never  heard 
of  it.  As  it  was  hard  work  pulling  against  the  stream,  he 
and  I  got  out  to  tow,  leaving  my  sister  to  sit  in  the  boat  and 
steer  ;  but  the  tow-Une  was  too  rotten  to  stand  his  energetic 
pulling,  and  broke  :  my  sister  was  left  helpless  with  one 
scull,  quite  ignorant  how  to  use  it  (we  had  fastened  the  other 
to  the  tow-line),  and  was  being  rapidly  carried  down  stream 
toward  a  weir,  when  Victor,  with  lightning  speed,  made  up 
his  mind,  tore  along  the  bank,  flinging  off  his  garments  as  he 
went  (which  I,  flying  after  him,  assiduously  picked  up),  dived 
in  ahead  of  the  boat,  swam  to  it,  climbed  in,  and  managed 
to  bring  it  ashore. 

It  was  very  early  in  his  student  days  that  he  took  up  the 
temperance  and  anti-tobacco  causes,  and  the  most  heated 
arguments  used  to  take  place,  particularly  at  Sunday  suppers, 
to  which  he  very  often  invited  one  or  two  of  liis  University 
College  friends.  My  father,  as  a  non-smoker,  cordially 
agreed  with  him  as  to  the  evils  of  tobacco,  but  was  inclined 
at  first  to  resent  his  abuse  of  '  God's  good  gift  '  of  wine  (an 
expression  which  particularly  roused  Victor's  ire),  though 
he  practically  became  a  teetotaller,  soon  after  that  time,  for 
the  rest  of  his  life.  We  had  a  clever,  reallv  brilliant,  German 
lady  living  with  us  as  governess,  and  after  my  parents  had 


24  SIR  VICTOR  HORSLEY 

gone  up  to  the  drawing-room,  tremendous  battles  would  take 
place  between  her  and  Victor  and  his  friends,  on  meta- 
physical and  religious  subjects,  to  which  I  would  Hsten  from 
a  (lark  comer,  hoping  that  I  should  not  be  noticed  and  sent 
to  bed.  W^en  Victor  was  a  small  boy,  I  think  he  was 
singularly  easygoing  and  good-tempered,  showing  none  of 
the  pugnacity,  and  impatience  of  other  people's  opinions, 
which  marked  his  later  life  :  but  with  the  dawn  of  his  intel- 
lectual development  these  characteristics  certainly  began  to 
show  themselves,  and  I  remember  a  desperate  row  with  the 
governess,  in  which  the  slamming  and  locking  of  the  dining- 
room  door  played  a  part,  though  I  have  forgotten  the  cause  of 
the  scene.  And,  a  little  later,  I  remember  his  withering  scorn  of 
our  poor  old  family  doctor's  methods  when  I  was  being  treated 
for  bronchitis ;  and  my  mother's  horror  at  his  blasphemy. 

There  existed,  in  University  College,  a  mixed  club — '  The 
Club,'  it  was  called  quite  simply — for  the  discussion  of  various 
subjects,  and  for  the  social  intercourse  of  the  men  and  women 
students,  and  at  one  of  the  meetings  he  read  a  paper  on 
Reformed  Dress  for  Women.  This  he  showed  me,  and  though 
my  blood  froze  at  the  appalling  spectacle  of  the  creature  he 
had  drauTi  in  illustration  of  the  scheme — a  female  in  trousers 
to  the  ankle  and  a  sort  of  very  full  frock-coat  buttoned  up 
to  the  throat — I  don't  remember  making  any  spoken  pro- 
test :  anything  he  thought  or  advocated  was  far  too  sacred 
to  be  objected  to  openly. 

Of  the  books  which  they  read  together,  Mrs.  Gotch  re- 
members Clough's  poems,  and  Bo3'd  Dawkins's  Early  Man  in 
Britain ;  and,  above  all,  Kingsley's  Yeast,  Two  Years  Ago, 
and  Health  and  Education.  They  put  themselves  heart  and 
soul  under  Kingsley's  authority  ;  he  gave  her  Kingsley's 
Life,  and  marked  passages  in  it  for  her,  and  she  writes  to  him, 
in  1879, '  I  am  still  busy  on  Health  and  Education,  but  I  don't 
know  when  I  shall  finish  it,  for  it  contains  such  mines  of 
thought  that  I  find  mj'self  dreaming  over  one  paragraph  till 
my  time  is  up.' 

On  April  5,  1878,  he  passed  the  first  examination  for  the 
membership  of  the  Royal  College  of  Surgeons,  and  on  May 
29  the  first  examination  for  the  fellowship.  Between  these 
two  examinations,  he  and  his  brother  Walter  were  at  the 
Easter  manoeuvres  : 

To  his  father.  April  20.  Sutton:  Carpenter's  shop.  You 
see  I  am  up  next  the  roof.  The  other  men  are  in  a  bam. 
By  the  way,  I  reported  of  it,  the  bam,  that  the  ventilation 


JAN.  1874— SEPT.  1878  25 

was  not  sufficient,  so  boards  were  stove  out.  We  are  on 
straw,  comfortable,  of  course.  We  marched  in,  having 
drilled  three  times  on  the  way,  which  set  the  men  up.  Have 
beef  here.  We  went  for  a  walk  round  town  after  adjutant's 
parade.  I  saw  tea  chalked  up  :  we  had  it  in  the  kitchen 
with  the  people,  which  was  very  jolly.  From  Mr.  Horsley 
to  Mrs.  Horsley,  April  24.  The  boys  turned  up  about  four 
o'clock,  looking  the  picture  of  health  and  strength.  They 
were  of  the  baggage-guard  coming  up,  and  slept  at  Mitcham 
last  night,  having  enjoyed  themselves  utterly,  Victor,  as 
usual,  the  most  loud  in  his  entoosymoosy. 

At  the  end  of  the  summer  se.ssion,  1878,  he  got  the  Filliter 
Exhibition  in  Pathological  Anatomy.  In  August,  he  passed 
the  first  examination  for  the  degree  of  Bachelor  of  Medicine 
of  the  University  of  London  :  he  was  in  the  first  class  in  both 
subjects,  anatomy  and  physiology  ;  and  he  got  the  gold 
medal  for  anatomy.  This  success  was  gained  under  diffi- 
culties, for  he  was  crippled  with  a  sore  foot.  The  family- 
hohday  this  summer  was  at  Fontainebleau  ;  he  joined  them 
after  a  sea-trip  to  Falmouth.  He  writes  from  London  to  his 
sister  Rosamund  in  Paris  : 

Aug.  I.  Fortunately  the  papers  have  been  easy  as  yet 
at  the  M.B.,  so  my  leg  has  not  had  much  effect.  I  suppose 
I  must  come  to  Fontainebleau  and  vegetate.  It  is,  of 
course,  a  great  nuisance,  as  I  just  wanted  to  get  into  decent 
training  after  the  last  nine  months.  Have  you  seen  the 
scientific  side  of  the  Exhibition  yet  ?  Try  and  find  out  the 
movements  of  the  troops,  i.e.  what  time  you  see  them  going 
to  or  coming  back  from  drill.  Aug.  4.  As  to  tiie  scientific 
part  of  the  Exhibition,  we  must  have  a  day  or  two  there 
together,  as  it  is  evidently  full  of  interest  and  objects  that 
you  will  understand  ^  aite  well  if  they  are  only  pointed  out. 
Of  course  all  my  plans  are  upset.  The  last  idea  is  that  I 
should  '  voyage  '  to  Falmouth  and  back  in  one  of  the  Irish 
steamers,  in  order  to  get  gaseous  food  in,  and  perhaps  let 
solid  food  out.  The  air  would  be  worth  anytliing.  ...  I 
have  ridden  into  town  every  day  in  a  hansom,  which  is  first- 
rate.  The  horses  seem  to  know  that  whenever  a  gap  occurs 
in  the  crowd,  they  are  to  run  for  it  :   consequently  need 

httle  stimulation.     Mr. came  yesterday  to  see  Walter's 

picture,  and  said  it  only  wanted  a  little  more  '  'eat  and 
'azincss  '  in  it. 

To  his  father,  Aug.  11,  ss.  '  Lady  Eglinton.'  Off  the  Needles. 
Coming  into  Portsmouth,  the  wind  dropped  a  ]ittl<\  and 
enabled  us  to  see  the  Fleet  at  anchor  splendidly.     The  Queen 


26  SIR  VICTOR  HORSLEY 

reviews  them  to-morrow.  The  first  line,  thirteen  ironclads, 
broadside  vessels.  The  second  hne  consisted  of  the  Turret 
Ships,  which  are  like  haystacks  with  most  of  the  sides  cut 
away,  since  they  are  all  painted  a  hideous  yellow-ochre 
colour.  Went  ashore  at  Southampton  into  the  public  park, 
which  was  yet  young  :  they  have  there  gymnastic  bars,  poles, 
ladders,  for  all  the  little  blackguards  to  fool  about  on.  A 
very  good  idea.  Southampton  is  a  straggling  place  of  no 
particular  architecture.  Aug.  15,  Hodge's  Temperance  Hotel, 
Falmouth.  In  the  evening  I  went  to  see  the  parade  of  the 
Falmouth  rifle  company,  over  120  strong.  With  more  look- 
ing after  by  the  N.C.O.s  they  would  be  very  good,  but  there 
was  too  much  talking,  and  the  rapidity  with  which  they 
stood  easy  at  the  word  Stand  at  ease  was  amazing.  They 
were  almost  all  fine  men,  the  average  height  being  quite 
5  feet  10  inches.  To-day  I  was  going  to  Truro,  but  coming 
out  I  met  a  man  who  is  in  the  '  Artists  '  :  he  offered  me  to 
fish,  so  we  went  out  at  nine  and  got  back  at  five.  In  running 
back  home  we  saw  a  shag  :  one  of  the  men  had  a  gun  aboard, 
so  we  tacked  all  over  the  place,  pursuing  the  beggar.  It 
was  a  glorious  joke.  Of  course  it  escaped,  after  two  pots 
at  it.  In  the  evening  I  went  to  the  Polytechnic  to  try  to 
get  a  book  out.  The  great  foods  here  are  pasties.  Fortu- 
nately this  hotel  is  invaded  (it  is  also  a  kind  of  eating-house) 
by  hosts  of  Cornish  tourists  from  Truro  and  the  inland,  who 
are  well  worth  watching.  Aug.  17.  Went  to  Truro  and 
back  yesterday,  up  the  river  Fal  12  miles.  Very  fortunate 
in  getting  into  museum  and  library.  I  called  on  a  Dr.  Jago, 
F.R.S.,  on  the  strength  of  my  calling,  as  I  found  he  was  a 
man  having  authority  in  the  place.  .  .  .  Cornwall  is  a  mass 
of  antiquities  and  scientific  objects  of  enormous  value,  so  it 
is  rather  hard  to  leave.  Obviously  a  walking  tour  is  the 
only  way  to  do  it. 

At  Fontainebleau,  he  and  Walter  studied  the  practice  of 
the  Artillery  School.  '  Our  two  volunteers,'  his  father 
writes,  '  are  of  course  much  interested,  and  most  critical,  in 
the  military  work.  They  had  a  narrow  escape  the  other  day, 
for  a  shell  burst  in  the  muzzle  of  a  large  howitzer  and  blew 
off  half  the  gun,  and  the  pieces  of  it  and  the  shell  were  droj> 
ping  all  round  them.'  From  Paris,  on  his  way  back  from 
Fontainebleau,  Victor  writes, '  The  Exhibition  is  disappoint- 
ing in  the  medical  line.  I  have  finished  the  pictures,  which 
took  me  a  day  and  a  half.  I  have  found  a  temperance  coffee- 
bar,  where  I  get  what  dinner  I  want.' 


Ill 

From  October  1878  to  May  1881 

Before  October  1878,  he  had  seen  something  of  the  practice 
of  the  Hospital,  but  as  it  were  on  sufferance.  Now,  he 
clerked  and  dressed  in  the  wards  and  out-patient  depart- 
ments, and  attended  lectures,  post-mortem  examinations, 
operations,  and  so  forth.  Like  many  students,  he  was  at 
first  unable  to  look-on  at  operations  without  faintness  ;  he 
would  get  a  friend  to  support  him,  or  would  leave  the  theatre 
for  a  few  minutes  and  come  back  to  it.  He  also  held,  at  one 
time  or  another,  junior  demonstratorships  in  anatomy, 
physiology,  and  pathology.  Dr.  Marten  of  Adelaide  re- 
members first  seeing  him,  as  a  junior  demonstrator  of 
anatomy,  in  1878  : 

We  first -year's  men  had  to  assemble  for  a  '  bone  class  '  at 
the  far  end  of  the  old  dissecting-room,  and  punctually  as 
the  clock  struck  noon,  in  walked  the  Demonstrator,  with  a 
lot  of  vertebrae  and  chalks.  He  had  a  quiet,  unassuming 
personality,  and  at  once  gained  our  attention,  for  he  ex- 
plained all  the  intricacies  of  the  bones  in  a  wonderful  way  : 
moreover,  he  had  the  happy  knack  of  so  imparting  knowledge 
that  it  seemed  to  remain  with  you  always. 

There  is  a  reference,  in  Gowers's  Diagnosis  of  Diseases  of 
the  Spinal  Cord — an  address  given  in  October  1879,  pub- 
lished in  1880 — to  some  anatomical  studies,  which  Horsley 
made  for  him,  on  the  relations  between  the  spinal  column 
and  the  origins  of  the  spinal  nerves. 

In  the  wards,  he  clerked  for  Dr.  Bastian,  and  dressed 
for  Mr.  John  Marshall.  It  is  well  known  of  Bastian  that 
he  was  the  last  of  the  opponents  of  Pasteur  and  Tyndall  in 
the  controversy  over  '  spontaneous  generation  '  ;  but  he  was 
also  one  of  the  founders  of  our  present  knowledge  of  the 
diseases  of  the  nervous  system.    He  is  in  the  company  of 

17 


28  SIR  VICTOR  HORSLEY 

Hughlings  Jackson,  Charcot,  Cowers,  Ferrier.  In  1879, 
Horsley  made  two  of  the  drawings  for  Bastian's  book,  pub- 
lished in  1880,  The  Brain  as  an  Organ  of  the  Mind,  and  in 
1880,  in  the  April  number  of  Brain,  Bastian  and  he  published 
a  paper,  'Arrest  of  development  in  the  left  upper  limb,  in 
association  with  an  extremely  small  right  ascending  parietal 
convolution.'  The  notes  and  drawings  of  this  case  had  been 
made  by  Horsley  in  1879.  To  the  same  year,  belong  some 
admirable  notes  and  microscope-drawings  of  two  cases  of 
tubercular  retinitis  ;  but  these  were  not  published.  The 
paper  in  Brain  is  his  first  contribution  to  medical  literature. 
In  it,  Bastian  and  he  refer  to  a  similar  case,  which  Cowers 
had  published  in  1878  :   then  they  say  : 

It  would  seem  that  we  have  here  another  instance  tending 
to  corroborate  the  view  that  there  is  a  correlation  of  some 
kind  between  the  functional  activities  of  these  regions  of  the 
ascending  parietal  convolutions  and  the  movements  of  the 
opposite  hand  and  fingers,  as  indicated  by  the  experimental 
observations  of  Dr.  Ferrier.  It  seems  something  more  than 
can  be  accounted  for  by  mere  coincidence  when  precisely  the 
regions  of  the  cortex  indicated  by  him  are  found  to  be 
defective  in  bulk  in  two  consecutive  cases  of  absence  or 
arrest  of  development  of  the  hand. 

In  1880,  Horsley  and  F.  W.  Mott  were  occupied  for  seven 
months,  off  and  on,  with  a  subject  of  bacteriology.  They 
published  their  results  in  the  Journal  of  Ph\'siology,  1882,  in 
a  paper  '  On  the  existence  of  bacteria,  or  their  antecedents, 
in  healthy  tissues.'  This  question,  whether  bacteria,  '  or 
their  antecedents,'  could  or  could  not  be  discovered  in  the 
healthy  tissues  of  newly  killed  animals,  was  regarded,  in 
1880,  as  a  great  stumbling  block  in  the  way  of  '  Listerism.' 
These  two  students,  who  afterwards  gained  such  high 
distinction,  were  already,  in  1880,  doing  bacteriological 
work  far  in  advance  of  their  contemporaries  :  they  planned 
it  and  completed  it  with  amazing  thoroughness. 

Thus,  when  he  was  not  yet  qualified  to  practise,  he  was 
teaching,  experimenting,  and  publishing  observations  in 
physiology  and  bacteriology.  But  his  leadership  of  his 
fellow-students,  his  irresistible  hold  over  them,  were  given  to 
him  not  by  these  advantages,  but  more  by  what  he  was  in 


OCT.  1878— MAY  1881  29 

himself.     One  of  his  contemporaries,  J.  E.  Hine,  afterwards 
Bishop  of  Northern  Rhodesia,  writes  : 

He  and  1  entered  the  Medical  School  on  the  same  day  in 
October  1S75.  That  year's  entry  was  a  good  one,  and  pro- 
duced some  men  who  have  become  well  known  :  Francis 
Gotch,  late  Professor  of  Physiology  at  Oxford,  F.  W.  Mott, 
Angel  Money,  Dawson  Williams,  Sidney  Martin,  C.  E.  Beevor, 
Bilton  Pollard,  Bond  of  Leicester,  were  all  contemporaries. 
Several  of  these  have  obtained  the  F.R.S. 

Our  teachers  at  University  College  Hospital  in  those  days 
were  Viner  EUis,  Burdon  Sanderson  (who  very  soon,  I  think, 
recognised  Horsley's  merits  and  powers),  Ringer,  Bastian, 
Russell  RevTiolds,  Wilson  Fox.  Among  the  younger  members 
of  the  Staff,  with  whom  Horsley  would  have  more  particu- 
larly to  do,  were  Marcus  Beck,  R.  J.  Godlee,  A.  E.  Barker, 
and  Cowers.  The  great  L.  S.  Jameson  (Sir  Starr)  was 
demonstrator  of  anatomy,  and  subsequently  resident  medical 
officer. 

I  remember  Horsley  in  those  days  as  a  keen,  energetic 
person,  with  a  '  dolichocephalic '-shaped  head,  always  with 
an  alert  look  and  with  an  inquiring  and  sceptical  mind.  I 
think  we  all  felt  that  he  had  a  future  before  him,  and  was  a 
greater  man  than  others  of  his  year.  Personally  he  was 
always  charming,  perfectly  '  straight,'  self-dependent.  He 
always  had  a  contempt  for  examinations  as  any  real  test  of 
knowledge  or  capacity.  He  had  a  strong  hatred  of  humbug 
of  all  kinds  :  he  protested  against  words  and  phrases  hke 
'  special  idiosyncrasy,'  which  he  called  a  mere  cloak  for 
ignorance.  He  also  held  strong  views  on  subjects  like  food, 
alcohol,  etc.  Mustard  and  suchlike  condiments  he  denounced 
with  vigour.  I  remember  once  in  a  debate  the  mustard 
question  came  up,  and  Dudley  Buxton  quoted  against  him 
Katharine's  saying,  in  The  Taming  of  tlie  Shrew,  about  a 
piece  of  beef  and  mustard — '  A  dish  that  I  do  love  to  feed 
upon  ' — but  this  carried  no  conviction  to  Horsley's  mind. 

I  have  no  letters  of  Horsley's.  I  only  corresponded  with 
him  once,  about  a  question  which  came  up  at  tlie  Lambeth 
Conference — danger  of  infection  by  use  of  the  chalice  in  the 
Communion.  Horsley  asked  me  to  go  and  see  him  and  talk 
it  over,  but  for  some  reason,  the  interview  fell  tlirough.  Our 
lines  had  drifted  too  far  apart  :  he,  the  great  surgeon  in 
London,  and  I  a  missionary  in  Central  Africa  for  twenty-five 
years. 

I  think  lie  enjoyed  '  having  his  knife  '  into  anybody — not 
surgicaUy  speaking,  but  metaj)horically :  anything  that 
seemed  to  him  an  abuse,  real  or  imaginary,  he  loved  to  attack. 
But  though  he  must  (?)  have  had  controversies  witii  many 
persons  in  different  connections,  I  think  every  one  must  have 


:^o  SIR  VICTOR  HORSLEY 

admired  him,   so  thoroughly  sincere,   genuine,  as  he  was, 
brilliant  in  intellect  and  blameless  in  life. 

Mr.  C.  J.  Bond  of  Leicester,  one  of  Horsley's  life-long  and 
closest  friends,  writes  : 

It  would  be  some  time  during  the  summer  session  of  1877 
that  he  first  invited  me  to  his  home  at  High  Row,  Kensington, 
and  I  remember  weU  the  amused  expression  with  wliich  he 
recounted  to  me  a  family  escapade  which  had  ended  in  injury 
to  one  of  his  father's  paintings.  This  occurred  from  an  over- 
zealous  practice  with  firearms  in  the  garden  behind  the  studio. 

About  this  time,  a  few  of  us  students  at  University  College 
became  interested,  as  young  men  with  inquiring  minds  are 
apt  to  be,  in  intellectual  problems  of  a  fundamental  kind, 
and  during  1878  Dudley  Buxton,  H.  D.  Waugh,  Harrington 
Sainsbury,  P.  Shearman,  Hubert  Murray,  Horsley,  myself, 
and  one  or  two  others  started  a  small  circle  called  the  Uni- 
versity College  Philomathic  Society.  One  of  the  earliest 
discussions  was  introduced  by  a  paper  by  Dudley  Buxton, 
'  Can  there  be  an  absolute  right  and  wrong,  independently  of 
a  Theistic  existence  ?  '  This  was  followed  by  papers,  in  the 
nature  of  rephes,  from  each  of  us  :  and  Horsley,  in  his 
contribution  to  the  discussion,  tried  to  show  that  the  follow- 
ing conclusions  were  justified :  (i)  The  question  of  the  exist- 
ence of  an  abstraction,  without  an  exact  knowledge  of  it,  is 
incapable  of  solution.  (2)  We  can  conceive  of  absolute 
right  by  the  use  of  our  experience,  employed  in  its  positive 
and  negative  aspects. 

It  must  have  been  in  connection  with  one  of  these  discus- 
sions that  Horsley  wrote  to  me,  just  before  the  summer 
vacation  of  1878,  '  You  are  sure  to  have  some  leisure  during 
the  next  two  months,  and  I  want  you  to  write  down  your 
own  idea  as  to  what  you  mean  by  "  the  soul."  Mind,  not 
any  one  else's  opinion,  but  your  own.'  I  still  have  this  letter 
and  my  own  in  reply,  and  though  youthful  enthusiasm  and 
inexperience  may  have  detracted  from  the  value  of  our  con- 
clusions, I  cannot  help  thinking  that  we  were  engaged  in  a 
not  wholly  useless  exercise. 

He  was  immensely  popular  with  fellow-students  and 
fellow-residents,  all  of  whom  he  was  ever  ready  to  help,  and 
I  remember  Marcus  Beck,  then  Assistant-Surgeon  to  the 
Hospital,  a  great  friend  of  the  students,  expressing  his  own 
finn  conviction  that  Horsley  was  a  genius  and  would  have  a 
brilliant  future.* 

*  To  be  praised  by  Marcus  Beck  was  one  of  the  finest  things  that  could 
happen  to  students  of  the  Hospital.  He  understood  them  perfectly  : 
they  coveted  his  good  opinion,  and  not  they  alone  :  his  memory  is  had  in 
reverence  by  everybody  who  knew  him.     There  was  no  man  at  the  Hospital 


OCT.  1878— MAY  1881  31 

I  left  the  Hospital  in  1879  ^^  t'^^^  ^P  ^  house-surgeoncy  at 
the  Bedford  General  Infirmary,  Horsley  came  down  to 
spend  some  days  with  me  in  the  old  building,  now  puUed 
down  to  make  room  for  the  modern  Hospital.  We  spent 
our  spare  time  boating  on  the  river  Ouse,  and  working  out 
some  details  in  the  microscopic  structure  of  the  salivary  glands 
of  the  green  woodpecker.  I  still  possess  some  sUdes  labelled 
in  Horsley 's  handwriting,  with  pencil-sketches  of  sections  of 
this  compound  gland. 

He  took  his  dominant  place  in  '  the  best  set ' — the  strong- 
\\'illed,  hard-thinking  young  men  who  are  the  making  of 
a  great  Medical  School,  wherever  they  are.  To  him,  now 
and  always,  everything  was  a  matter  of  principle,  and  he 
defended  his  opinions  so  earnestly,  and  so  good-naturedly, 
that  where  lesser  men  would  have  lost  influence,  he  gained  it. 
He  did  not  stop  at  renouncing  theatres  and  wine  and  tobacco. 
He  hated  loose  talk,  and  would  not  let  it  pass  ;  and  he 
obeyed,  all  his  life,  the  rule  of  absolute  chastity.  He 
delighted  to  help  men  over  their  work.  And  in  everything 
he  had  a  way  with  him,  a  magic  of  his  own.  For  his  de- 
votion to  bacteriology — which  then  was  a  new  science,  full 
of  large  and  amazing  surprises — they  called  him  the  Germ  : 
other  names,  less  often  used,  were  the  Professor,  which 
explains  itself,  and  the  Vulture,  for  his  insistence  on  the 
value  of  post-mortem  studies  :  and  a  later  name  was  Archibald 
Allright,  for  his  invincible  optimism. 

At  Christmas-time,  1878,  he  got  a  couple  of  days  of  hard 
walking  in  Kent :  '  We  lunched  at  Brasted  for  the  magnificent 
sum  of  3d.  The  village  is  shopless  and  consists  of  four  or 
five  houses,  but  was  called  by  one  of  the  aborigines  a  "town." 
.  .  .  There  was  a  very  nice  little  Inn  at  Hever,  but  the  vicar 
had  filled  it  with  wedding  guests,  and  so  we  had  to  come  on 
here  (Edcnbridge).  .  .  .  Bridge  rocks  are  very  magnificent, 

whom  Horsley  more  admired.  As  he  said,  many  years  later,  in  his  address 
to  the  Sheffield  Medical  Scliool,  1 895, '  If  you  ask  nie  for  a  Ruitle  or  example, 
I  can  at  once — thouj^h  not  a  believer  in  hcro-worsliip — point  to  one  who 
was  a  striking  example  of  the  powerful  inllucnce  for  good  tliat  some  men 
evidently  exert.'  lie  went  on  to  sjwak  of  (Juy  dc  Chauliac's  ideal  surgeon  : 
'  bold  when  sure,  cautious  in  danger,  kind  to  the  sick,  friendly  with  fellow- 
workers,  constant  in  duty,  not  greedy  of  gain.'  'These  words  are  now 
placed  on  the  memorial  to  Mr.  Beck  in  University  College  Hospital,  and 
just  as  he  showed  us  in  his  life  how  true  they  arc,  so  let  us  also  keep  them 
before  us  to  remind  us  what  should  bo  the  ciiaractcr  of  our  life's  work.' 


32  SIR  VICTOR  HORSLEY 

like  Fontainebleaii  only  very  much  more  so.  .  .  .  The  view 
into  the  misty  Weald  under  the  sunset  was  scrumptious.' 
In  August  1879,  he  and  Dudley  Buxton  and  Walter  Pearce 
had  a  walking  tour  in  Cornwall  and  Devon.  The  letters  of 
this  holiday  are  illustrated  with  rough  sketches,  and  they 
are  of  prodigious  length  :  '  Strange  to  say,  I  have  developed 
a  feeling  at  any  rate  (not  to  say  more)  for  letter  writing.' 

Aug.  21,  St.  Just.  At  Padstow  a  ferryman  swindled  us 
with  great  success,  so  Pearce  was  instructed  to  put  a  spoke 
in  his  wheel  if  possible  with  the  authorities.  In  this,  how- 
ever, our  charitable  intentions  were  frustrated,  as  the  beggar 
had  a  private  contract,  and  had,  it  appeared,  done  the  Town 
Constable  under  similar  circumstances.  The  Padstow  people 
are  quite  satisfied  to  drink  solutions  of  their  decomposing 
ancestry,  I  suppose  in  order  that  family  characteristics  may 
be  perpetuated.  ...  As  we  came  over  the  cliffs  into  New 
Quay,  we  passed  two  tumuli,  one  of  which  had  been  opened 
and  stiU  showed  the  stone  '  chest  '  grave  very  beautifully. 
I  have  made  a  sketch  of  it.  Later  I  found  in  New  Quay  the 
farmer  on  whose  land  they  were  opened  by  Mr.  Borlase,  and 
from  him  found  that  the  only  implement  discoverable  was 
of  stone.  .  .  .  All  the  further  country  to  Perran  Porth  lay 
across  genuine  sand-dunes,  the  likes  of  which  I  don't  much 
mind  if  I  don't  go  over  again.  .  .  .  There  was  extensive 
lead-mining  on  the  dunes,  but  all  are  now  abandoned,  the 
same  general  misery  being  found  all  over  the  country.  Here 
at  St.  Just  there  are  only  three  working  out  of  seventeen. 
At  St.  Ives  we  found  a  man  of  U.C.H.  lately  set  up,  and 
with  him  went  to  Hayle  regatta :  the  day  would  have 
been  very  slow  had  not  we  luckily  got  into  a  fishing  lugger 
and  pulled  the  sweeps  round  home.  St.  Ives  is  a  marvellous 
place  as  being  the  resort  of  humdrum  lives  and  bad  smells. 
The  upper  ten  play  Pope  Joan  for  five  hours  at  a  stretch, 
finished  with  a  heavy  supper  and  instant  departure.  To-day 
we  walked  past  Gurnard's  Head  and  over  regular  moor 
country.  St.  Just  is  a  town  much  too  large  for  itself.  We 
had  a  jolly  climb  round  tlic  cliffs  :  the  spray  was  magnificent, 
just  like  big  guns.     I  wish  Rosamund  were  here. 

Aug.  23.  Penzance:  Matthew's  Temperance  Hotel.  .  .  . 
The  poor  inland  of  Cornwall,  an  unfertile  moorland  covered 
with  heather  save  where  cultivated — grey  granite  blocks, 
looking  as  if  they  had  seen  any  number  of  cycles,  standing 
boldly  through  the  peat,  not  afraid  of  any  knockdown  blows 
the  weather  may  offer  them.  Of  course,  taken  thus  alone, 
such  scenery  is  very  grand,  and,  however  wretched  to  some 
people,  there  is  nothing  more  jolly  to  me  than  to  see  the 


OCT.  1878— MAY  1S81  33 

grey  mist  waving  about  such  hills,  and  the  lonelier  the  bttter. 
But  there  is  one  feature  in  tlie  landscape  which  introduces 
misery  into  the  view,  accordingly  deducting  from  our  pleasure, 
and  that  feature  is  the  constant  occurrence  of  a  disused 
mine.  ...  At  St.  Just,  I  and  Buxton  slept  in  a  fairly  narrow 
bed  with  not  many  clothes,  and  yet  I  kicked  not,  neither  did 
I  struggle,  finally  waking  in  the  position  in  which  I  fell 
asleep.  .  .  .  From  Land's  End  to  Logan  Rock  we  thought 
ourselves  clever  by  taking  off  our  boots,  etc.  and  wading 
through  the  surf.  The  end  of  it  was  we  had  to  swarm  up 
the  granite  cUff,  and  so  got  to  the  Logan,  which  was  a  fraud 
inasmuch  as  it  would  not  '  log.'  However,  that  was  a  small 
matter,  as  we  had  a  jolly  good  climb  to  get  at  it.  As  we 
came  away,  we  saw  a  tripper  and  a  guide  !  Such  is  the  folly 
of  mankind  ;  moreover,  as  we  were  having  lemonade  and 
milk  at  Porthguarra,  a  cub-party  hove  in  sight,  consisting 
of  the  tutor,  a  pale-faced  man  with  a  green  silk  umbrella, 
and  the  following,  which  was  made  up  of  youths  and  boys 
of  various  ages.  The  Logan  Rock  is  obviously  a  perfectly 
natural  production,  and  old  Borlase  and  traditions  may 
hypothesize  any  number  of  Druids,  but  on  poor  basis.  .  .  . 
Of  course,  one  learns  all  through  every  tour  how  to  do  the 
thing  better,  and  this  much  is  '  klar,'  that  Cornwall  can  only 
be  properly  done  by  staying  at  places  and  then  scrambHng 
about  eveiywhere  all  day  long.  Every  rock  comer  is  well 
worth  climbing  round. 

Penzance  is  a  very  clean  town,  and  like  many  Cornish 
towns,  several  of  the  gutters  have  hillside  Icats  running  in 
them.  The  aborigines  are  a  go-ahead  people,  and  have  had 
a  fine  Geological  Institute  since  1833.  Their  minerals  are 
very  fine.  The  fossils,  of  course,  I  have  seen  before,  but 
found  more  I  had  not  noticed  before.  Unfortunately  their 
Biological  Museum  and  Archajological  ditto  are  in  a  very 
poor  state,  and  I  suppose  as  tin  is  down  so  everything  goes  : 
the  biological  interest  has  flagged  terribly.  However,  it 
may  yet  move.  .  .  .  We  first  went  to  the  Museum  and  then 
over  the  rocks  to  the  Mount.  The  granite  rock  driven  up 
through  the  slate  makes  a  splendid  eyrie,  and  I  only  wish 
it  were  mine  to  live  in.  I  should  fortify  it  to  the  teeth  and 
have  a  splendid  laboratory  fitted  vsith  every  imaginable 
instrument  and  reagent.  At  Mousehole  we  hired  a  man,  who 
was  much  amused  and  puzzled  when  Pearcc  and  myself 
discussed  his  fare  in  Gcnnan.  He  was  a  very  fine  fellow, 
and  told  us  no  end  of  a  lot.  He  is  in  the  Naval  Reserve, 
and  looked  for\vard  to  using  the  Henry  Martini.  I  wish  you 
were  here  as  I  could  show  you  no  end. 

Aug.  24.  Plymuuth:  Wolfrey's  Temperance  Hotel.  We 
strolled  round  to  the  Barbican  and  soon  got  into  a  boat. 
Buxton  and  I  pulled  up  to  Oreston,  while  Pearce  extracted 

c 


34  SIR  VICTOR  HORSLEY 

from  the  boatman  the  old  story  how  drink  had  entirely 
broken  up  liis  family  and  left  him  with  no  resources  what- 
ever :  he  was  half  screwed,  and  when  we  landed  at  Oreston, 
wanted  half  a  pint,  but  we  shoved  him  off  into  deep  water 
again,  so  he  went  back.  ,  .  .  The  nautical  folk  here  are 
very  jolly,  and  I  only  wish  we  were  staying  a  month  to  enjoy 
the  place  thoroughly — enjoy  it,  not  as  the  Plymouthians 
seem  to  do,  viz.  after  the  manner  of  Vanity  Fair,  but  one 
could  spend  more  than  months  in  rowing  round  all  the  inlets. 
Next  day  we  went  straight  down  to  the  Barbican  again  and 
got  hold  of  our  yesterday's  man,  old  Cowell,  who  was  sober, 
and  pulled  away  across  the  Catwater  under  the  lee  of  Baggy 
Point,  and  dived  off  the  boat  into  the  deep  green  sea.  We 
tossed  and,  as  I  won,  rowed  back  again.  Then  we  went  for 
Stonehouse,  walked  round  the  Devil's  Point  into  the  Victual- 
ling Yard.  The  biscuit  is  very  jolly  eating,  and  I  wouldn't 
mind  a  turn  with  our  bread.  .  .  .  From  the  Victualling  Yard 
we  went  up  to  a  fort,  sat  on  a  wall  and  ate  our  sandwiches, 
then  dropped  down  on  Devonport  Dockyard.  Of  course 
we  were  shown  round  by  a  policeman,  but  Buxton  was  done 
up  and  Pearce  does  not  care  much  for  military  equipage,  so 
we  were  hurried.  Must  go  through  it  another  day  by  oneself 
with  a  pass.  Then  we  went  up  to  Stoke  Park  to  enjoy  the 
perspective.  As  we  came  down  the  hill  to  go  into  Plymouth, 
we  passed  the  Military  Hospital,  but  as  it  was,  unfortunately, 
eighty  years  old,  we  did  not  learn  much  from  the  N.C.  who 
showed  us  over. 

Aug.  29.  Lee,  near  Ilfracombe.  .  .  .  Newton  Abbot  must 
be  a  deadly  alive  place,  for  the  poor  visitors  were  reduced  to 
archery.  After  condoling  with  the  Newtonians  and  regret- 
ting that  we  could  not  attend  the  Wesleyan  Conference,  we 
were  wedged  into  a  carriage  with  bulky  females  who,  for 
the  most  part,  luckily  got  out  at  the  next  station.  After 
longsuffering  we  got  out  ourselves  at  Torquay,  and  repaired 
along  the  searoad  on  the  general  skoot  to  a  Temperance 
House.  There  are,  it  seems,  three  British  Workman  Houses 
erected  by  a  kind  of  coffee  subscription.  .  .  .  The  '  garrison  ' 
consisted  of  two  men,  whom  we  designated  mutes,  as  they 
never  spoke  even  to  each  other,  a  middle-aged  female  who 
might  have  been  a  lady's-maid,  and  two  other  males  who 
produced  literature  and  slept  heavily  over  their  intellectual 
fare.  We  cleaned  up,  went  to  a  barber's,  were  scraped, 
and  then  found  out  Tuke's  abode  by  my  geograpliical  nose. 
His  mother  and  sister  are,  of  course,  very  nice  people  and 

very  sociable.     Staying  with  them  is  a  Miss  ,  also  a 

Quakeress  :  she  is  very  interesting  indeed,  has  read  a  great 
deal,  and  can  talk  and  reason  very  well  and  correctly.  .  .  . 
The  two  girls  came  out  in  waterproofs  and  sensible  boots. 
Their  boots  were  not  thick  enough  in  the  sole,  but  the  heels 


OCT.  1878— MAY  1881  35 

were  first-rate,  and  as  they  don't  wear  stays  and  dress  very 
quietly,  you  can  understand  that  they  are  very  rational. 

Miss  wants  to  be  a  medical  student,  so  I  told  her 

what  to  do.  I  hope  she  will  take  up  science  at  any  rate,  as 
there  are  evidently  plenty  of  brains  behind  a  red  collection 
of  hair  to  work  whatever  she  turned  to.  Well,  we  took  them 
round  Kent's  Cavern,  and  gave  lectures  at  various  points  : 
Pearce  worried  the  old  man  who,  fortunately,  only  became 
extremely  communicative,  just  as  a  bit  of  lard  gets  more  oily 
if  you  finger  it.  Of  course  the  best  point  is  the  enormous 
age  of  the  bears'  remains.  ...  I  think  the  Museum  is 
capital,  and  only  wants  extending  in  other  directions  to  be 
of  the  greatest  possible  value.  We  came  here  by  train  after 
spending  a  dehghtful  hour,  which  I  wish  had  been  many 
others,  in  the  Museum  at  Exeter. 

In  contrast  with  the  fault  of  hardness  in  these  letters 
there  is  a  letter  to  his  sister  Rosamund,  April  1880  ;  a  week- 
end with  the  Pearces  at  Maidenhead.  He  tells  her  every- 
thing :  the  look  of  the  orchards,  '  every  branch  seemed  to  be 
loaded  with  flowers,  and  the  air  was  scented  as  we  rode  past ' ; 
the  look  of  the  woods  and  the  riverside,  and  Marsh  Lock — 
'  you  may  judge  how  well  the  water  looked,  as  perfectly 
green  and  white  it  rushed  over  the  different  weirs  and  through 
the  penstocks  :  at  one  place  in  particular  one  could  look  up 
through  the  water  to  the  sky,  and  it  was  just  the  appearance 
of  a  transparent  mass  of  spar  ' — and  the  final  flower  gather- 
ing— '  in  a  small  shaw  out  in  a  field,  where  bluebells  and 
primroses  and  anemones  grew  rampant.  Besides,  in  our 
absence,  Mrs.  Pearce  had  collected  a  quantity  of  garden 
flowers,  so  that  each  of  us  was  armed  with  fine  bouquets  for 
the  Hospital.^  .  .  .  There  is  an  old  navvy  in  the  Hospital, 
who  is  a  native  of  Lincolnshire,  though  naturally  he  has 
travelled  about  a  great  deal  in  following  work.  He  told  me 
an  immense  amount  of  interesting  facts  about  the  frns  : 
how  that  in  sinking  wells  they  came  generally  on  llint- 
bearing  chalk  ;   that  the  peat  subsoil  was  often  16  feet  thick 

•  He  writes  to  .Mrs.  Sthiifer,  June  2O,  1882,  '  Wards  i  and  2  desire  to 
assure  Mrs.  Scliiifcr  tl-.at  tlic  Depth  of  (iratitudc  fell  by  tlieni  on  receiving 
the  quite  too  lovely  Water-Ldies  canNOT  be  expressed  by  the  70,000 
resourccsof  the  British  lanf^uage.'  in  December  1882,  when  he  was  warded 
in  Hospital,  she  sent  him  some  flowers.  He  wrote  back,  *  To  say  that  I 
make  a  worship  of  llowers  would  be  as  much  an  exagRcration  as  to  say  that 
any  one  thing  is  my  solitary  object  of  devoUon,  but  that  I  am  exce!>^ivcly 
fond  of  them  13  as  equally  true.' 


36  SIR  VICTOR  HORSLEY 

and  then  came  clay.  He  said,  too,  that  the  trunks  of  trees, 
which  of  course  are  commonly  found  in  peat,  frequently  lay 
in  one  direction  for  some  distance.  The  wood  is  usually 
carbonised,  Uke  the  Irish  bog-oak.' 

In  November  1880,  he  passed  the  final  examination  for 
the  membership  of  the  Royal  College  of  Surgeons.  He 
writes  to  his  father,  November  18,  '  I  have  managed  the 
M.R.C.S.  all  right,  although  they  adopted  a  bullying  tone 
which  shifts  my  centre  of  equihbrium  ;  so  that  I  am  now 
qualified  to  practise.'  Then,  a  short  holiday,  by  sea  from 
Liverjwol  to  Gibraltar  :  some  water-colour  sketches  are  left 
from  it,  but  no  letters.  In  December,  he  went  into  residence 
at  the  Hospital,  for  six  months,  as  House-surgeon  to  Mr. 
John  Marshall.  Thus,  the  end  of  his  home  life  came  of 
necessity,  with  the  change  of  his  work ;  and  it  was  oppor- 
tune :  for  he  had  outgrown  the  constraints  of  home,  and 
had  departed  from  its  religious  observances.  The  Sunday 
mornings  were  given  to  microscope-work,  at  a  table  in 
Walter  Horsley's  studio ;  Victor  and  a  friend  worked 
together  over  the  fascinating  but  secular  pursuit  of  the 
embryology  of  the  mouse.  The  Sunday  evenings  drifted 
into  controversy.  The  younger  children  used  to  dread 
sitting  as  models  to  their  father ;  for  he  could  not  keep 
himself  from  questioning  them.  '  Where  does  the  boy  get 
these  monstrous  opinions  from  ?  '  he  would  say  to  them. 
It  was  who  should  have  him,  the  Hospital  or  home :  and 
the  Hospital  won,  hands  down.  In  the  later  years — it  was 
not  all  his  fault — he  gradually  let  his  old  home  stand  too 
far  in  the  background  of  his  crowded  life. 

The  term  of  residence  in  Hospital,  as  a  House-physician 
or  House-surgeon,  is  likely  to  be  one  of  the  happiest  times  of 
a  doctor's  existence.  It  gives  him  that  quiet  sense  of  be- 
longing to  the  place,  that  enjoyment  of  privilege  and  of  near 
friendship,  which  make  Cambridge  and  Oxford  so  delightful ; 
and  it  gives  him  responsibility  and  experience,  more  than  he 
would  get  in  the  time  from  either  University.  In  this 
charmed  circle,  Horsloy  was  Mr.  John  Marshall's  House- 
surgeon  from  December  1880  to  the  end  of  May  1881.  Mr. 
Marshall  was  one  of  his  father's  friends  and  colleagues. 


OCT.   1878— MAY  1881  37 

for  he  was  Professor  of  Anatomy  at  the  Royal  Academy. 
He  was  a  Fellow  of  the  Royal  Society,  Professor  of  Surgery 
at  University  College,  and  senior  surgeon  to  the  Hospital, 
and  in  1883  President  of  the  Royal  College  of  Surgeons  : 
a  courteous  gentleman  and  a  good  scholar.  His  daughter 
writes  that  Horsley  '  was  his  favourite  student.  I  know  that 
he  thought  very  highly  of  him,  and  took  him  to  assist  at 
private  operations,  and  on  one  occasion  left  him  to  take 
charge  of  the  patient,  the  first  night  after  a  very  severe 
operation.' 

There  are  two  letters  of  this  time,  from  Horsley  to  his 
sister  Rosamund  : 

U.C.H.,  March  3,  1881.  .  .  .  Don't  forget,  if  possible,  to 
bring  up  some  flowers  for  this  benighted  spot  in  Creation. 
My  last  set  of  dressers  ornamented  the  women's  ward  with 
pots  of  flowers,  as  a  passing  souvenir.  It  was  a  very  good 
idea  of  theirs,  and,  of  course,  was  considerably  appreciated. 
There  is  so  much  to  do  now  that  we  have  no  time  for  general 
amusements,  hence  absence  of  news.  ...  I  have  got  a  new 
set  of  dressers  who  are  a  very  superior  lot  to  the  other  set 
of  rascals,  who  I  could  barely  trust  out  of  my  sight,  and  who 
played  the  fool  most  unaccountably  under  any  circumstances. 

March  12.  ...  As  my  week  began  on  Wednesday,  this  is 
the  first  moment's  peace  I  have  had,  and  even  now  I  ought 
not  to  be  writing,  but,  as  it  will  save  a  post,  an  effort  is 
desirable.  Multitudinous  thanks  for  the  primroses,  which 
are  the  cynosure  of  many  neighbouring  eyes  and  have  made 
glad  the  hearts  of  men  and  women.  I  have  put  into  the 
box  some  dissecting  instruments,  in  case  they  may  be  of  use 
to  you.  ...  I  have  had  a  frightful  week  of  it.  Cases  keep- 
ing me  up  till  four  o'clock  in  tiie  morning.  On  Saturday  at 
midnight  we  had  an  amputation  at  the  shoulder  joint,  and 
on  Monday  evening,  as  we  had  arrived  at  the  cheese,  or,  as 
we  call  it,  the  soap  stage  of  dinner,  a  child  was  brought 
choking  to  the  door  and  apparently  expired  there  and  then. 
However,  I  cut  into  the  trachea,  and  Maudslcy  and  I  sucked 
the  blood  and  mucus  out  of  the  said  pipe,  whrroupon  after 
doin;:^  artificial  rc'Si)ir;ition  for  a  (juarttT  of  an  hour,  it  came 
to  life  again.  It  was  generously  presented  by  its  fellows 
with  a  piece  of  raw  Spanish  chestnut,  which  it  promptly 
inhaled  :  of  course  aspliyxia  was  the  result.  Well,  it  coughed 
the  bit  of  nut  through  the  silver  tube  put  into  the  trachea, 
so  that  now  its  chance  of  life  is  very  good  indeed  :  conse- 
quently Maudslcy  and  I  are  very  cockalioop  about  it,  as  the 
other  fellows  gave  it  up,  ui  fact,  two  went  away  and  said 


38  SIR  VICTOR  HORSLEY 

wc  were  wasting  uui  luiie.  As  we  did  not  know  whether  it 
had  diphtlieiia  or  not,  we  washed  our  mouths  out  with 
quinine,  wliereupon  the  unfortunate  Maudsley  reproduced 
his  dinner,  and  was  promptly  offered  another  by  the  Resident 
Med.  Offr.,  who  is  the  dinner  president,  but  this  last  offer 
he  did  not  accept. 

He  lillcd  ills  days  with  work  :  his  room  at  the  Hospital 
bore  witness — the  table  covered  with  books  and  papers,  the 
arm-chair  made  impossible  l^y  microscope-shdes  laid  out  on 
it  to  dry  :  he,  in  the  middle  of  it  all,  would  gravely  practise 
his  rifle-drill. 


IV 

From  i88i  to  1884 

The  term  of  residence  in  Hospital  seems  to  have  told  on 
his  health,  for  Mr.  C.  J.  Bond  writes  : 

It  was  during  his  House-surgeoncy,  1880-81,  that  Horsley 
suffered,  for  some  time,  from  a  troublesome  cough,  and  was 
told  by  one  of  the  physicians  to  the  Hospital  that  he  had 
phthisis.  This  led  to  his  writing  me  a  characteristic  letter, 
in  which  he  referred  to  the  disease,  and  to  one  of  its  un- 
favourable signs.  With  this  letter  came  a  beautifully  made 
little  trephine,  4  mm.  in  diameter,  suitable  for  operation 
on  the  frog's  skull.  We  had  been  discussing,  on  several 
occasions,  the  great  field  that  was  waiting  for  exploration 
in  the  physiology  and  surgery  of  the  central  nervous  system. 
We  had  been  bemoaning  the  small  results  that  had  attended, 
up  to  that  time,  the  treatment  of  cerebral  and  cerebellar 
abscess.  Mace  wen's  epoch-making  work  had  not  then  been 
published,  and  Horsley  felt  keenly  tliat  tlic  time  had  come 
for  more  active  surgical  intervention  in  these  and  other  head 
cases.  And  the  point  of  his  giving  me  the  little  trephine 
was,  that  Willie  Tuke,  a  brilliant  fellow-student  and  a  great 
friend  of  Horsley 's,  had  just  been  struck  down  by  phthisis, 
from  which  he  died  :  Horsley,  in  view  of  his  own  persistent 
cougii,  feared  that  he  might  share  this  fate,  and  he  was  deeply 
anxious  that  these  new  problems  in  cerebral  and  spinal 
surgery  should  be  grappled  with  in  the  near  future,  even 
though  he  might  be  prevented  by  illness  from  taking  an 
active  part  in  the  campaign. 

The  little  trephine  was  used  during  the  following  vacation 
at  my  home  in  Leicestershire,  and  I  well  remember  the  interest 
with  which  he  listened  to  my  description  of  the  effect  of 
removing  the  greater  portion  of  the  cerebral  hemispheres  in 
the  toad  :  the  arrest  of  the  toad's  instinctive  habit  of  digging 
itself  into  loose  ground,  at  the  approach  of  winter,  by  an 
outward  shovelling  movement  of  the  Hexed  hind  limbs. 

It   may   be    that    Horsley   was   ni   immediate   danger   of 
phthisis ;  but  he  had  no  trouble  of  that  sort  in  the  later  years. 

19 


40  SIR  VICTOR  HORSLEY 

The  diagnosis  of  phthisis  could  not,  in  1881,  be  decided  by 
the  finding  of  tubercle-bacilli  in  the  sputa  ;  for  Koch's  dis- 
covery of  the  bacillus  was  not  made  known  till  1882.  It 
appears  that  he  said  nothing  to  his  people  of  what  had  been 
told  him.  Doubtless  he  was  resolved  that  they  should  not 
send  him  out  of  London. 

During  his  House-surgeoncy,  or  just  after  it,  he  began  a 
long  series  of  experiments  on  his  own  brain.  Many  of  us, 
going  under  an  anesthetic,  have  watched  with  interest,  and 
with  anxiety,  the  gradual  blotting-out  of  our  faculties  ;  but 
not  man}'  of  us  would  care  to  do  what  Horsley  did.  He  an- 
aesthetised himself,  or  got  a  friend  to  ancesthetise  him,  it  is  said 
about  fifty  times  in  adl :  it  might  be  partially,  or  it  might  be 
completely  ;  and  he  devised  ways  of  recording  and  signaUing 
his  experiences. 1  Dr.  Marten  of  Adelaide  writes  :  '  He  used 
to  come  into  our  sitting-rooms,  where  having  set  us  down 
at  a  table  with  pen  and  paper,  he  proceeded,  whilst  lying 
back  in  an  armchair,  to  administer  chloroform  to  himself. 
At  his  dictation  we  had  to  write  down  in  what  order  his  cere- 
bral centres  became  inactive.  It  was  found  that  the  loss  of 
brain  function  always  took  place  in  the  same  order,  and  that 
after  he  was  able  only  to  mumble  a  few  words  he  could  still 
move  his  arms.  When  quite  imconscious,  we  had  to  remove 
the  mask  and  allow  him  to  sleep  off  the  effects  of  the  drug.' 
Dr.  G.  E.  Tw3'nam  remembers  giving  him  gas  three  times  at 
one  sitting.  Mr.  Salter  Chappell  remembers  an  occasion 
when  Horsley  was  no  sooner  out  of  the  ancesthetic  than  he 
demanded  to  be  put  under  it  again  ;  but  the  anaesthetist 
objected — If  anything  went  wrong,  what  should  he  do  if 
ever  he  met  Horsley's  father  ?  '  Well,'  said  Horsley,  '  you 
would  raise  your  hat  like  a  gentleman,  of  course.'  For  some 
experiments,  he  took  not  gas  but  ether.  It  is  said  that  the 
Hospital  authorities  called  the  attention  of  the  Staff  to  the 
strange  increase  of  consumption  of  the  gas.     From  studying 

*  There  is  a  reference  to  these  rather  hazardous  performances  in  his 
Lees  and  Raper  Memorial  Lecture,  1900.  His  notes  and  signalling  codes 
were  the  beginning  of  a  collection  which  he  made  of  examples  of  oddities 
and  vagaries  of  the  brain's  action  in  fatigue  or  disease;  the  trailing-off  of 
a  man's  writing  if  he  falls  asleep  over  it,  the  meaningless  repetitioo  of 
phrases  in  a  letter,  and  so  forth. 


FROM   1881  TO  1884  41 

his  highest  cerebral  centres,  he  went  on  to  study  his  reflexes. 
As  he  sa^-s  in  his  '  Note  on  the  patellar  knee-jerk/  published 
in  Brain,  October  1883  : 

...  I  venture  to  record  a  few  observations  on  the  con- 
dition of  this  phenomenon  when  the  subject  of  experiment 
is  under  the  influence  of  nitrous  oxide  gas.  In  1S81,  while 
experimenting  (on  myself)  with  this  gas  for  a  different  pur- 
pose, it  occurred  to  me  to  contrast  the  condition  of  the 
superficial  and  deep  '  reflexes.'  ...  To  avoid  the  possibility 
of  error  in  stating  the  depth  of  narcosis,  only  the  result  of 
experiments  (fifteen  in  number)  made  on  myself  is  here 
stated,  but  the  facts  were  verified  by  observations  made  on 
other  subjects. 

In  all  cases  the  anaesthesia  was  complete.  .  .  .  The  anaes- 
thesia was  pushed  until  rigidity  and  sometimes  cyanosis 
resulted.  The  recovery  of  consciousness  was  very  frequently 
attended  with  considerable  muscular  spasm  and  semi-co- 
ordinated convulsive  struggles  and  excitement.  The  '  re- 
flexes '  were  examined  at  regular  intervals  of  five  seconds, 
from  the  commencement  of  the  experiment  to  the  return  of 
consciousness. 

In  the  summer  of  1881,  he  took  the  degrees  of  Bachelor  of 
Medicine  and  Bachelor  of  Surgery  of  the  University  of 
London.  The  gold  medal  in  surgery  was  awarded  to  him, 
with  an  University  Scholarship.  He  did  not  proceed  to  the 
degree  of  Master  of  Surgery. 

At  the  end  of  1881,  he  went  to  Berlin  and  Leipzig.  He 
lived  in  Berlin  with  the  Oppenheims,  friends  of  his  people, 
and  relations  of  Mendelssohn,  and  he  had  letters  of  intro- 
duction to  other  friends  in  Berlin  from  his  aunt.  Miss  Sophy 
Horsley.     He  writes  to  her,  from  Leipzig  : 

Stadt  Rom  Hotel,  Dec.  18,  1881.  Of  course  I  was  very 
sorry  to  leave  Berlin,  but  Leipzig  is,  on  the  whole,  more 
interesting  in  a  general  way.  Of  course  one's  acquaintance 
with  Londtm  aiul  Paris  docs  not  allow  of  one's  finding  nuich 
novelty  in  P.orlin,  except  in  the  '  manners  and  customs  of 
the  aborigines.'  ...  In  HerUn  I  believe  I  saw  all  that  was 
possible  in  the  time,  and  at  any  rate  all  that  was  immediately 
necessary  for  me  to  see.  The  life  at  the  Oppenheims  was 
just  like  being  at  home,  and  all  their  friends  did  not  srem 
strangers  at  all,  so  that  it  is  (juite  iinj)ossiblc  that  any  visit 
could  have  been  much  more  agreeable.  Leij)zig  is  beautiful, 
although  Mis.  Wach  has  just  left  nie,  saying  that  she  thought 


42  SIR  VICTOR  HORSLEY 

it  '  hasslich.'  The  odours  are  very  powerful  indeed  for  winter 
tinie,  but  all  the  back  alleys,  the  market,  etc.,  are  splendid 
and  '  quite  too  '  mediaeval.  The  people,  too,  are  different 
from  the  Berliners,  and  it  is  always  very  amusing  to  wacch 
foreigners,  especially  when  they  are  in  their  native  wiids. 
{N.B. — My  letters  are  always  egotistical,  so  the  occurrence 
of  '  I  '  in  the  following  must  not  be  a  surprise.)  The  train 
from  Berlin  was  supposed  to  be  a  Schnellzug  direct  to  Munich, 
but  all  the  trains  here  run  as  if  time  was  no  object  to  any- 
body. It  arrived  at  Leipzig  about  twelve  midday,  I  was 
conducted  to  a  droschky,  the  horse  of  which  had  a  method 
of  progression  quite  peculiar  to  himself,  viz.  a  succession  of 
small  hops  in  which  the  whole  body  of  the  animal  moved  as 
one  piece.  It  was  physically  interesting,  but  not  conducive 
to  rapid  progression.  .  .  .  Berlin  and  Leipzig  are  upside  down 
with  preparations  for  Christmas,  and  the  Augustus  Platz 
here  is  full  of  Christmas  trees,  which  are  the  tops  of  fir-trees 
stuck  into  square  bits  of  wood  as  stands.  There  is  no  snow 
or  ice,  which  is  a  mystery  to  the  populace  and  a  grief  to  the 
shopkeepers,  w-ho  say  here  that  the  people  don't  buy  so  much 
because  it  is  not  a  genuine  Weihnachtszcit.  Yesterday  I 
paid  a  visit  to  Prof.  Cohnheim,  who  was  very  kind,  in 
fact  he  had  previously  been  primed  up  by  Mrs.  Wach.  Un- 
fortunately he  does  not  know  any  English,  but  I  take  headers 
into  German  sentences,  and  if  survival  occurs  the  people 
generally  understand.  It  is  evident  that  this  is  the  best 
Medical  School,  and  it  would  be  very  jolly  to  stop  some 
time.     The  surrounding  country,  however,  is  hideous.* 


1882  [est.  25) 

8|[Hc'  and  C.  J.  Bond,  this  year,  were  sharing  a  bedroom  and 
a  sitting-room  at  loi  Charlotte  Street,  Fitzroy  Square  ;  a 
little  shabby-genteel  street,  not  far  from  the  Hospital  : 
more  shabby  now  than  genteel,  but  it  has  this  distinction, 
that  the  Rossetti  family  lived  in  it.     Bond  was  working  for 

'  There  is  a  letter  from  Mr.  Oppenheim  to  Mr.  Horsley,  dated  December 
20,  Unter  den  Linden,  8  ;  'I  must  tell  you  and  Mrs.  H.  how  very  much 
we  enjoyed  Victor's  visit,  and  congratulate  you  to  such  a  son.  Of  course 
I  knew  very  little  of  him  until  now,  but  I  grew  very  fond  of  him  and  so 
does  my  wliolc  family.  My  wife  told  me  so  often  and  the  two  girls  ex- 
press repeatedly  their  dissatisfaction,  that  "  der  englische  Herr  Horsley  ' 
has  left  us  already.  It  is  a  pity  indeed  that  his  visit  was  so  short.  His 
fresh,  modest,  natural  way  took  all  our  hearts,  and  besides  he  has  the 
exquisite  recommendation  to  be  so  much  like  his  father.  When  he 
laughed,  or  explained  a  thing,  or  told  a  story,  we  thought  him  exactly  like 
the  "  old  one."  (I  beg  your  pardon,  only  in  comparison  of  course.)  Of 
course  this  is  his  less  imiwrtant  side,  but  he  is  certainly  on  the  way  to 
become  a  man  above  the  average.     VVe  all  griisiien  Victor  intensely.' 


FROM  1881  TO  1884  43 

the  Fellowship  of  the  Royal  College  of  Surgeons.  He  writes 
that  Horsley  '  never  seemed  to  get  tired  in  those  days.  On 
one  occasion,  after  working  in  the  wards  all  day,  we  passed 
the  night  in  the  post-mortem  house,  carrying  out  operations 
on  the  dead  body,  and  resumed  our  Hospital  duties  as  usual 
next  day.'  And  he  remembers  that  Horsley,  in  1882,  had 
not  the  democratic  mind  of  the  later  years  :  '  his  outlook  at 
this  time  on  many  sides  of  life,  and  on  many  sociological 
problems,  was  distinctly  conservative.' 

During  1882-84,  Hoi-sley  was  Surgical  Registrar  to  the 
Hospital.  It  was  his  business  to  see  that  the  students  took 
proper  notes  of  all  surgical  cases  allotted  to  them,  to 
arrange  and  have  charge  of  these  notes,  and  to  draw  up 
annual  reports.  The  Surgical  Registrar  is  always  in  and 
out  of  the  wards  ;  he  gives  informal  teaching  to  the  House- 
s'irgeons,  students,  and  nurses;  he  is  in  close  touch  with 
the  Staff,  and  is  marked  for  promotion  among  them  ;  and, 
best  of  all,  he  has  endless  opportunities  for  learning,  because 
every  surgical  case  in  the  Hospital  comes  under  his  observa- 
tion. The  appointment  is  non-resident  :  he  is  free  to  start 
in  private  practice,  and  to  pursue  lines  of  w^ork  of  his  own, 
so  far  as  he  has  time. 

In  1882  also,  Horsley  was  appointed  Assistant-Professor 
of  Pathology.  These  two  appointments  kept  him  close  to 
the  Hospital.  Dr.  Marten  remembers  of  him  as  Surgical 
Registrar,  that  '  he  weis  most  indefatigable  in  his  work,  and 
a  most  pleasant  man  to  have  any  dealings  with.  He  in- 
variably came  to  the  Hospital  between  nine  and  ten  o'clock 
at  night,  and  dear  old  Lizzie  Church,  the  head  nurse  of  the 
ward,  always  made  him  a  large  basin  of  bread  and  milk 
before  he  left  for  home.'  In  his  work  for  the  Department  of 
Pathology,  he  was  no  less  keen  :  ho  would  take  any  amount 
of  trouble  to  obtain  specimens,  and  to  get  leave  for  post- 
mortem examinations. 

In  March  1882,  he  made  two  cxpcrinKnts  on  the  injection 
or  transplantation  of  particles  of  tumours  ;  one  from  man 
to  a  cat,  the  other  from  a  rat  to  a  rabbit.  One  of  them  gave 
a  positive  result  :  the  specimen  wiu^  placed  in  University 
College  Museum.     There  is  a  note  by  him,  dated  January 


44  SIR  VICTOR  HORSLEY 

1882, '  Causes  of  failure  in  transplantation  of  tumours.  Con- 
sidering the  results  obtained  in  transfusion  of  blood  (Schafer, 
Landois,  Blundeli,  etc.),  failure  probably  due  to  the  fact  of 
one  tumour  substance  not  being  transplanted  into  animal 
of  same  or  very  closely  allied  genus.  Transplantation  from 
man  should  be  made  into  monkeys  or  domesticated  cami- 
vora.  Transplantation  from  rats  into  rats  and  rabbits, 
guinea  pigs,  etc' 

During  the  spring  of  1882,  he  was  writing  a  Report  for  the 
Local  Government  Board,  '  On  "  septic  bacteria,"  and  their 
physiological  relations.'  He  had  been  instructed  to  report 
especially  on  the  chemical  action  of  bacteria,  and  their  pro- 
duction of  '  sepsin.'  It  was  a  long  piece  of  work,  fifty  pages, 
with  a  list  of  two  hundred  and  ninety  references.  On 
May  23,  at  a  meeting  of  the  Royal  Medical  and  Chirurgical 
Society,  he  showed  some  of  these  bacteria — wound-infection, 
pyaemia,  anthrax.  Watson  Cheyne,  at  the  same  meeting, 
showed  the  bacilli  of  tubercle. 

In  July,  he  was  making  some  drawings  for  the  ninth 
edition  of  Quain's  Anatomy.  He  writes  from  the  Hospital, 
on  July  25,  to  Mrs.  Schafer,  apologising  for  delay  ;  no  ice 
for  the  microtome,  therefore  no  drawings  for  the  Professor, 
who  was  one  of  the  editors  : 

It  is  to  be  hoped  that  the  recording  angel  wept  sufficiently 
to  blot  out  the  Professor's  language  on  not  finding  the 
drawing  among  his  letters.  Fact  is,  this  noble  and  charitable 
institution  was  reduced  yesterday  afternoon  to  enough  ice 
for  one  small  but  severe  emergency,  and  though  the  district 
was  scoured  as  far  as  Holborn,  no  ice  could  be  obtained  for 
money  or  really  love,  since  a  Hospital  porter  could  scarcely 
be  expected  to  develop  a  sudden  affection  for  an  ancient 
ice-mercliant,  even  to  aid  in  the  noble  work  of  illustrating  the 
new  '  Quain.' 

He  contributed  two  articles  this  year,  '  Zyme  '  and 
'  Bacilli,'  to  Quain's  Dictionary  of  Medicine.  But  there  is 
more  interest  in  Mr.  Bond's  account  of  an  observation  which, 
in  1882,  was  a  discovery  indeed  : 

One  hot  Sunday  in  the  summer  of  1S82  I  spent  at  Wimble- 
don with  Frank  Penrose.  In  the  course  of  an  afternoon 
ramble,  Penrose  and  I  noticed  a  mouse  sitting,  in  a  partly 


FROM  t88i  to  1884  45 

conscious  condition,  with  a  roughened  coat,  on  the  side  of 
the  railway  bank  near  Penrose's  iiouse.  The  mouse  was  so 
ill  that  it  allowed  me  to  pick  it  uj),  and  we  examined  a  drop 
of  its  blood  under  the  microscope  on  reaching  the  house.  We 
found  the  blood  crowded  with  actively  moving  trypanosomes 
(probably  Lewisii),  and  I  took  several  films  back  with  me  to 
London.  Penrose  showed  a  slide  next  day  to  Ray  Lankester, 
who  was  at  that  time  Prof,  of  Zoology  in  the  College. 
Horsley  took  a  great  interest  in  the  investigation  :  he  stained 
a  number  of  films  to  show  the  parasite,  and  in  his  cheery  way 
wrote  a  large  label  on  one  slide,  To  C.  J.  Bond,  from  his 
devoted  admirers. 

In  October,  he  and  Bond  got  the  delight  of  a  holiday  in 
Italy.  They  had  planned  for  Egypt,  hoping  to  see  some- 
thing of  the  military  surgery  of  the  Egyptian  campaign  ;  but 
this  plan  failed,  so  they  went  by  sea  to  Genoa  ;  then  Pisa, 
Naples,  and  Paistum,  then  Rome,  and  back  through  Florence, 
Venice,  and  Milan.  Horsley  had  armed  himself  with  a 
revolver  against  possible — in  1882  not  impossible — brigands, 
and  on  board  ship  the  two  young  men  were  allowed  to  prac- 
tise with  it.  Town  or  country,  they  made  good  use  of  their 
time  :  but  the  holiday  was  too  much  of  a  rush.  Mr.  Bond 
remembers  a  visit  to  the  Dohm  marine  biological  station  at 
Naples  ;  a  walk  by  moonlight  through  Pompeii,  and  a  wordy 
conflict  with  a  sentry  ;  the  malarial  look  of  many  of  the 
country  children  ;  Horsley 's  keen  imaginative  enjoyment 
of  Rome  ;  a  visit  to  the  laboratory  of  Marchiafava,  who  was 
working  at  malaria ;  and  the  horrid  sight,  in  a  Rome  hospital, 
of  maggots,  dropped  from  wounds,  on  the  floor  of  the  ward. 
In  Florence,  in  the  Pitti  Palace,  they  met  Lord  Leighton, 
who  gave  them  a  discourse  on  the  pictures.  Between 
Florence  and  Venice,  the  Po  was  in  flood,  and  they  were 
rowed  over  submerged  tobacco-fields  from  one  point  of  the 
line  to  another.  There  arc  postcards  from  Horsley  to  his 
people :  and  a  long  letter  to  his  sister  Rosamund,  from  Rome, 
telling  her  everything.  It  is  Imperial  Rome  that  he  most 
cares  for  ;  next  in  honour  comes  the  SLstine  Chapel.  He 
says  nothing  of  Italian  art  before  the  time  of  Michael  Angelo  ; 
he  has  that  contempt  for  Bernini  which  is  natural  to  youth  ; 
and  he  is  made  angry  by  the  dirtiness  and  the  neglect  of 
Rome  as  it  then  was  : 


46  SIR  X'irTOR  HORSLEY 

The  whole  town  reeks  with  work  by  Bernini  and  his 
school.  .  .  .  Bernini  is  responsible  for  '  decorating  '  the 
Bridge  of  St.  Angelo  with  ridiculous  figures  of  angels.  Ridi- 
culous because  their  legs  are  all  in  the  same  position,  and 
their  fingers  and  arms  extended  like  marionettes — '  You 
hold  yourself  like  this,'  etc.  etc.  .  .  .  The  remains  of  the 
Imperial  buildings  are,  of  course,  indescribable,  the  only 
drawback  being  the  awful  state  of  smash  and  indefiniteness 
in  which  they  are  at  the  present  time.  Fortunately,  by 
means  of  thorough  excavation  and  by  the  happy  existence 
of  plans,  medals,  etc.,  a  fairly  accurate  restoration  is  pos- 
sible, but  the  feeling  of  every  one  with  any  archaeological 
ideas  must  be  unpleasant  if  not  disappointing.  Of  course 
one  is,  to  a  certain  extent,  prepared  by  engravings,  pictures, 
etc.,  but  none  of  these  convey  a  tenth  either  of  instruction 
or  pity  that  the  actual  ruins  do.  .  .  .  Everywhere  in  Rome 
the  same  thing  is  to  be  seen,  namely,  black  ruins  crowded 
round  by  houses,  usually  dirty  and  repulsive  in  appearance. 
It  is  from  not  appreciating  these  facts,  although  one  has  so 
often  seen  them  drawn  in  etchings,  Piranesi,  etc.,  that  dis- 
appointment and  regrets  come  over  you.  So  you  had  better 
take  this  warning. 

In  November  1882,  he  moved  from  Charlotte  Street  to 
129  Gower  Street,  where  he  was  only  a  few  yards  from  the 
Hospital  and  the  College.  Here  he  lived  with  his  friend 
(Sir)  Arthur  Whitelegge  :  a  few  years  later,  they  were  not 
only  friends,  but  brothers-in-law.  Gower  Street,  in  a  quiet 
way,  has  been  helpful  to  many  young  physicians  and 
surgeons  of  the  Hospital,  making  them  comfortable  till  they 
could  make  themselves  eminent.  The  house  has  a  pleasant 
look ;  and  here  Horsley  put  up  his  name,  and  stayed  till 
1885.  There  was  some  delay  over  the  brass  plate :  '  the 
lazy  man  who  makes  them  never  managed  to  be  at  home 
when  I  called  '  :  but  by  February  1883  it  was  on  the  door. 

During  his  time  in  Gower  Street,  he  wrote  a  slasliing  paper 
for  the  Students'  Medical  Society,  '  On  the  evil  effects  of 
Tobacco.'  It  is  unanswerable  :  his  list  of  the  many  poisons 
in  the  plant,  his  facts  and  evidences,  his  instances  from 
Bertillon,  make  a  heavy  indictment.  But  he  is  even  more 
concerned  with  the  ethical  objections.  There  is  a  passage 
which  recalls  what  was  so  characteristic  of  him,  his  clean 
fastidiousness — as  he  said  long  ago  to  a  friend  who  was 
smoking,  '  Why  spoil  the  beautiful  things  on  God's  earth  by 


FROM  1881  TO  1884  47 

creating    such    a    horrible    smell  ?  ' — and    his    aristocratic 
dislike  of  all  violence  done  to  the  natural  goodness  of  things  : 

Nothing  is  more  depressing,  in  the  enjoyment  of  a  glori- 
ously fine  day  and  keen,  bracing,  cool  air,  than  suddenly  a 
cloud  of  tobacco  smoke  trailing  in  front  of  one's  face.  To 
my  mind,  it  is  just  as  objectionable,  from  an  abstract  point 
of  view,  as  the  snobbishness  of  writing  one's  name  on  old 
ruins,  and  as  wantonly  mischievous  as  the  wholesale  murder 
of  seagulls  by  so-called  sportsmen  on  our  coasts.  For  it  is 
the  destruction  of  a  beautiful  thing.  With  what  ulterior 
object  ?  Why,  simply  the  injurious  narcotisation  of  only 
one  individual  of  the  community. 


1883  {ist.  26) 

With  the  move  to  Gower  Street,  he  became  more  attentive 
to  social  life  :  his  letters  in  1883  touch  the  year's  interests 
in  art,  the  Rossetti  Exhibition  at  Burlington  House,  the 
performance  of  Lohengrin  at  Covent  Garden,  and  of  Caste 
at  the  old  Prince  of  W^ales's  Theatre.  He  writes  to  Mrs. 
Schafer  of  a  plan  for  a  theatre  party  : 

A  '  tea  in  the  North  is  understood  to  mean  the  '  high  ' 
tea  of  the  South,  viz.  one  in  which  the  demoralising  action 
of  theine  is  to  a  certain  extent  counteracted  by  larger  than 
usual  doses  of  food,  which  it  is  hojicd  will  have  the  power  of 
supporting  the  system  during  the  tiirilling  scenes  of  Caste. 
Of  course,  I  mean  the  whole  party  of  dissipators  to  meet 
here.  My  landlady,  though  accustomed  to  great  eccen- 
tricities in  the  way  of  suddenly  providing,  likes  to  know 
beforehand. 

Other  letters  to  her  are  to  say  that  he  cannot  come  to  a 
party,  or  to  a  temperance  meeting  : 

Jtily  18.  I  found  so  much  to  do  with  the  M.R.C.S. 
youths  that  I  filt  obliged  to  offer  them  another  demonstra- 
tion, which  met  with  a  reception  that  I  must  attcnij)!  to 
justify.  As  they  arc  in  great  triijiilation,  I  shall  not  csrapc 
before  five.  July  28.  I  'm  awfully  sorry  to  say  that  I  'vc 
a  tea-fight  on  Monday,  in  this  way — I  have  instituted  this 
sort  of  thing,  viz.  a  tea  meeting,  in  order  to  collect  the  new 
clerks  in  an  unofficial  way,  so  that  they  should  fraternise 
and  I  should  instil  into  them  my  notions  of  surf;ical  note- 
taking.  I  am  vrry  sorry,  .'is  on»'  does  not  do  anylhinf;  in 
the  way  of  preaching  the  Temperance  Gospel  outside  this 


48  SIR  VICTOR  HORSLEY 

place,  and  the  susceptible  British  public  is  ready  to  listen  to 
either  Medicine  or  the  Church  on  this  subject. 

And  there  are  three  letters  which  are  delightful  because 
we  have  the  key  to  them.  The  Schafers  had  persuaded  him 
to  read  A  Chance  Acquaintance,  by  W.  D.  Howells:  a  httle 
work  of  art  so  dehcate  that  the  young  people  of  the  present 
generation  would  find  it  too  mild  for  them.  He  takes  with 
bewildering  solemnity  this  featherweight  story  of  a  broken 
engagement,  and  says  what  he  thinks  of  it  : 

To  Professor  Schafer.  Nov.  3.  I  have  read  the  Chance 
Acquaintance,  and  must  say  I  don't  like  it.  The  heroine  is 
a  vulgar  little  wretch  ultimately  guilty  of  utter  meanness. 
However,  am  much  obhged  to  you  for  it,  as  it  extends  one's 
reading.  I  return  it  herewith.  To  Mrs.  Schafer.  Nov.  5. 
I  think  Kitty  was  vulgar  (i)  Because  she  fell  in  with  her 
odious  cousin's  plan  and  actually  put  on  her  cousin's 
CLOTHES  !!!!!!  to  appear  better  in  Mr.  A.'s  eyes.  (2)  Be- 
cause she  advanced  towards  him  and  encouraged  him  when 
really  she  hadn't  made  up  her  mind  in  the  least  as  to  what 
she  really  felt  towards  him,  and  when  she  actually  had  no 
real  sympathy  with  him  or  his  ideas.  .  .  .  Fancy  rushing  into 
public  curiosity  the  moment  it  was  settled.  ...  I  think  the 
American  notion  of  people  meeting  in  that  sort  of  way  and, 
without  anything  like  a  complete  knowledge  of  each  other's 
ideas  and  ways  of  thinking,  settling  down  for  hfe  together,  is 
too  ridiculous,  and,  of  course,  ends  notoriously  in  early  and 
frequent  separations.  ...  I  have  for  some  years  past 
watched  this  side  of  life  on  the  European  and  American 
systems,  and  am  strongly  in  favour  of  '  long  service.'  To 
Mrs.  Schafer.  Nov.  8.  ...  It  certainly  never  entered  my 
head  that  Mr.  A.  was  ashamed  of  Kitty  when  the  Bostonians 
appeared,  for  it  appears  to  me  absolutely  impossible  that  a 
man  could  be  ashamed  of  the  girl  he  really  loved.  The 
thing  is  so  absurd  that  it  did  not  even  occur  to  me. 

We  require  some  explanation  of  this  tirade  ;  and  we  find 
it  in  the  light  of  the  fact  that  he  was  just  engaged  to  be 
married.  He  and  Miss  Eldn^d  Bramwell,  a  daughter  of  Sir 
Frederick  Bramwell,  became  engaged  in  October  1883. 
There  had  long  been  friendship  :  the  daughters  of  the  two 
famiUes  had  met  at  Lord  Armstrong's  country  house,  and 
in  London  houses  ;  and  the  Bramwells  one  summer  had 
taken  Willesley.  Earlier,  the  young  ladies  had  gone  together 
to  VV^illesley  for  a  few  days'  holiday,  in  which  they  were  to 


FROM   1881  TO  1884  49 

'  do  ever^'thing  for  themselves  ' ;  and  he  had  suddenly  joined 
them ;  come,  he  said,  to  black  the  boots  and  carry  the  coals 
and  be  generally  useful.  He  writes  to  his  sister  Rosamund, 
'  Things  always  come  all  right  in  the  end.  One  can  only  be 
aware  that  the  ship  is  only  launched  and  that  hfe  really 
begins  now.'  And  to  Mrs.  Schafer,  '  Yes,  I  was  "sick"  of, 
or  rather  at,  your  note  ;  but  it  was  because  there  was  not 
enough  of  it.  My  appetite  for  communications  is  insatiable. 
As  I  habitually  feel  about  90  per  cent,  more  than  I  express 
in  words,  you  will  understand  me  in  my  most  gratefully 
appreciating  the  kindness  of  your  postscript.  Like  all  my 
friends  you  are  too  kind,  if  it  were  possible.  Of  course  We 
are  burdened  with  theories  of  existence,  and  it  will  be 
amusing  to  see  what  our  line  will  be  like  compared  to  the 
theoretical  one.' 

Lesser  events  of  1883  were  as  follows,  (i)  On  May  26, 
he  became  a  Fellow  of  the  Royal  College  of  Surgeons.  (2) 
On  December  6,  Mr.  John  Marshall  gave  the  Bradshaw 
Lecture  '  On  the  operation  of  nerve  stretching  for  the  relief 
or  cure  of  pain.'  Horsley  made  diagrams  and  microscope- 
specimens,  and  some  experiments  on  the  dead  body,  for  this 
lecture  ;  and  drawings  for  it  when  it  was  pubhshed.  (3)  On 
December  13,  at  a  meeting  of  the  Physiological  Society,  he 
read  notes  '  On  four  cases  of  injury  of  the  brain,  illustrating 
the  position  of  the  motor  centres.'  ^ 

1884  {cBt.  27) 

In  this  memorable  year  came  the  beginning  of  his  work 
with  Professor  Schafer,  the  beginning  of  his  work  with  Dr. 
C.  E.  Beevor,  and  his  appointment  to  the  Brown  Institution. 

He  published  three  papers  this  year,  (i)  '  On  a  case  of 
occipital  encephalocele,  in  which  a  correct  diagnosis  was 
obtained  by  means  of  the  induced  current.' — Brain,  July 
1884.     (2)  '  On  substitution  as  a  means  of  restoring  nerve 

'  See  Journal  of  Physiology,  vol.  iv.  supplement,  p.  5.  In  one  of  thase 
cases,  he  had  taken  a  muscle-tracing.  '  This  showed  minimal  and  maxi- 
mal contractions  of  the  muscle,  most  of  which  appeared  to  be  single  waves 
although  the  longest  (at  the  end)  were  of  no  less  than  ^\  sec.  duration. 
Query.  Direct  discharge  from  the  cortex  of  the  cerebrum  through  the 
cells  of  the  anterior  cornua  of  the  spinal  cord  (acting  as  conductors)  to  tho 
muscles  ?  ' 

D 


50  SIR  VICTOR  IIORSLEY 

function,  considered  with  reference  to  cerebral  localisation.' 
— Lancet,  July  5,  1884.  (3)  '  Consensual  movements  as 
aids  in  diagnosis  of  disease  of  the  cortex  cerebri.' — Med. 
Times,  August  16,  1884.  But  more  effect  was  produced  by 
his  paper  at  a  meeting  of  the  Royal  Medical  and  Chirurgical 
Society,  January  22, '  On  the  existence  of  sensory  nerves  and 
nerve  endings  in  nerve  trunks,  true  "  nervi  nervorum."  ' 
This  paper  was  much  talked  of :  for  it  gave  a  precise  answer 
to  a  precise  question  which  Marshall  had  just  been  asking 
in  his  Bradshaw  Lecture  :  '  Have  the  nerves  got  nerves  of 
their  own  ?  Is  the  sheath  of  a  nerve  sensitive  ? '  There  was 
some  evidence,  but  no  proof,  of  the  existence  of  these  nerves 
of  nerves.  Horsley,  by  a  then  new  method  of  section- 
staining,  demonstrated  them  in  a  human  nerve.  Up  to  the 
time  of  the  reading  of  his  paper,  he  had  not  found  them  in 
sections  of  animal  nerves ;  and  it  does  not  appear  that  he 
pursued  the  enquiry  further :  there  was  no  reason  why  he 
should. 

Toward  the  end  of  the  year,  he  writes  to  Mrs.  Schafer  : 

As  regards  my  '  future  existence,'  I  found  that  pure 
Science  meant  either  waiting  an  interminable  time  before 
'  settling  '  was  possible,  or  it  meant  more  or  less  exile,  and  an 
early  marriage.  Personally  I  would  rather  strike  the  happy 
mean,  and  therefore  am  busy  taking  a  house  in  Grosvenor 
St.,  the  lower  regions  of  which  I  shall  occupy  mj'sclf,  and  let 
the  rest  until  the  said  settling  becomes  practicable.  There 
was  a  determining  element  also  in  the  fact  that  Eldred  wanted 
me  to  go  in  for  Surgery  and  not  pure  Pathology.  In  any 
case  (as  you  know),  I  believe  that  the  most  solid  work  in 
Pathology  has  been  done  by  men  in  practice,  and  at  least 
one  wiU  have  an  idea  as  to  what  is  more  likely  to  be  practically 
useful  in  the  way  of  Research. 

He  was  Professor-Superintendent  of  the  Brown  Institution 
for  six  years,  from  1884  to  1890.  Things  have  so  changed, 
that  even  the  name  of  the  Institution  is  hardly  kno\vn  to 
the  younger  members  of  his  profession,  and  they  have  no 
idea  of  its  importance  thirty  years  ago.  It  was  founded  by 
Mr.  Thomas  Brown  of  Dublin.  He  died  in  1852  :  he  left  a 
sum  of  money  to  the  University  of  London,  '  for  the  found- 
ing, establishing,  and  upholding  an  Institution  for  investigat- 
ing,   studying,    and,    without    charge    beyond    immediate 


FROM  1881  TO  1884  51 

expenses,  endeavouring  to  cure  maladies,  distemf)ers,  and 
injuries,  any  quadrupeds  or  birds  useful  to  man  may  be 
found  subject  to.'  The  Institution  was  to  be  within  a  mile 
of  either  Westminster,  Southwark,  or  Dublin  :  and  the 
University  of  London  was  empowered  to  appoint  a  Com- 
mittee '  to  control  the  number  and  cases  of  diseased  or  in- 
jured animals  to  be  taken  charge  of,  and  to  decide  about  the 
purchase  of  diseased  or  injured  animals  or  their  carcases  for 
the  promotion  of  science,  as  well  as  for  to  determine  about 
any  contingency  not  hereinbefore  provided  for  relative  to 
the  said  Animal  Sanatory  Institution.'  The  site  for  the 
Institution,  149  Wandsworth  Road,  S.W.,  was  purchased 
by  means  of  gifts  of  £2000  from  Mr.  John  Cunhffe  and  £700 
from  Professor  Burdon  Sanderson.  The  Institution  was 
not  estabUshed  till  1871.  The  value  of  the  legacy  was  by 
that  time  about  £33,000. 

By  1871,  the  study  of  pathology  was  very  different  from 
what  it  had  been  in  1852.  The  University  therefore 
established  the  Institution  not  only  as  a  veterinary  hospital 
for  the  study  and  treatment  of  the  diseases  and  injuries  of 
animals,  but  also  as  a  centre  for  advanced  physiological  and 
pathological  research.  They  appointed  Burdon  Sanderson 
to  be  its  first  Professor-Superintendent.  After  him  came 
Greenfield,  Roy,  Horsley,  Sherrington,  Rose  Bradford,  and 
Brodic.  The  present  Superintendent  is  Mr.  Twort ;  whose 
work  on  Johne's  disease  of  cattle  is  well  known  to  all  patho- 
logists. These,  all  of  them,  arc  the  names  of  men  of  science, 
who  would  regard  human  pathology  and  animal  pathology 
as  one  and  indivisible,  and  would  make  use  of  the  experi- 
mental method.  The  hospital  department  of  the  Institution 
was  not  in  any  way  interfered  with  or  neglected  :  it  was 
thoroughly  elficient,  and  more  than  200,000  animals  have  by 
this  time  been  treated  as  '  in-patients  '  or  as  '  out-patients  ' ; 
but  the  research  department  was  far  beyond  the  range  of 
veterinary  practice,  and  wiis  concerned  with  the  most 
advanced  study  of  problems  of  general  physiology  and 
pathology.  To  be  working  at  the  Brown  Institution  was 
of  itself  a  notable  privilege.  There  was  no  Lister  Institute : 
and  the  science  departments  of  the  Medical  Schools  were 


52  SIR  VICTOR  MORSLEY 

planned  not  for  research  but  for  elementary  teaching.  The 
Brown  Institution,  small  and  out  of  the  way  though  it  was, 
had  great  influence  and  authority.  Special  investigations 
were  made  there  (or  the  Local  Government  Board,  the 
London  County  Council,  the  Army  Veterinary  Department, 
the  Royal  Agricultural  Society,  the  Grocers'  Company,  and 
the  Royal  Society. 

Thus  it  gave  Horsley  just  what  he  wanted  ;  not  only  a 
lal)oratory  of  his  own,  but  a  little  Academy  of  his  own.  It 
put  him  at  the  head  of  a  group  of  diligent  young  men,  each 
working  independently,  but  all  willing  to  take  a  suggestion 
from  him.  Besides,  it  made  him  thoroughly  famihar  with 
the  diseases  of  animals.  And  it  brought  him  into  touch, 
here  and  there,  wuth  public  affairs. 

But  the  Institution  in  later  years  lost  ground,  and  now 
is  almost  forgotten.  It  never  was  large  enough,  nor  central 
enough,  to  capture  the  attention  of  London  ;  the  forces  of 
anti-vivisection  were  brought  against  it ;  and  it  was  never 
free  from  poverty.  Again  and  again,  in  his  annual  reports, 
Horsley  complains  of  the  want  of  money  for  its  proper 
maintenance  :  in  the  1887  report,  for  example,  he  writes 
as  follows  of  the  want  of  proper  arrangements  for  the 
hospital  department : 

It  will  be  seen  that  the  gravest  operations  are  attended 
with  a  most  regrettably  high  mortality.  I  have  elsewhere 
dwelt  strongly  upon  tlie  popular  delusion  that  the  wounds 
and  surgical  treatment  generally  of  the  lower  animals  require 
less  care  and  attention  than  those  of  man.  In  fact,  to  ensure 
the  healing  of  wounds  without  suppuration  and  inflamma- 
tion it  is  necessary  to  adopt,  as  far  as  possible,  the  most 
rigid  antiseptic  precautions.  I  have  been  always  very  anxious 
that  this  fact  should  find  practical  expression  in  the  work 
of  our  Institution.  It  has  been  perfectly  possible  to  carry 
this  out  in  the  laboratory  work,  the  value  of  which,  in  many 
cases,  is  entirely  dependent  upon  its  achievement ;  but  I 
regret  to  say  that  it  is  impossible  in  the  present  state  of  the 
Hospital  to  attempt  it  in  the  hope  of  success.  For  we  have 
no  room  or  ward  which  we  can  set  apart  for  operations,  we 
have  no  operating  tables,  we  have  none  save  impromptu 
means  for  deaUng  with  post-operation  surgical  emergencies. 
All  these,  the  essentials  of  success  in  modern  surgery,  would 
of  course  be  at  our  disposal,  if  the  pubUc  gave  to  us  those 


FROM  t88t  to  1884  53 

funds  which  are  collected  by  so-called  '  Anti-vivisectionists,' 
and  spent  in  wanton  and  mendacious  abuse  of  the  Institu- 
tion and  its  work. 

Later,  came  the  beginning  of  things  as  they  are  now :  more 
advantages  for  research  at  the  Universities  and  Medical 
Schools  ;  the  establishment  of  the  laboratories  of  the  Royal 
Colleges  of  Physicians  and  of  Surgeons ;  and  the  founding 
of  the  Lister  Institute.  It  was  impossible  for  the  httle  house 
and  sheds  in  the  Wandsworth  Road  to  hold  out  against  these 
odds.  Last  of  all  came  the  War.  To  see  the  Brown  Insti- 
tution now,  is  to  wish  that  the  University  of  London  would 
either  make  an  end  of  it  altogether,  or  keep  it,  after  the  War, 
as  nothing  more  than  a  veterinary  hospital.  The  pursuit 
of  physiology  and  pathology  has  been  attracted  away  from 
it,  and  will  never  come  back.  In  Horsley's  time  there  was 
a  company  of  men  working  there:  now,  the  Superintendent 
is  aU  alone :  even  the  hospital  department  is  at  vanishing 
point.  After  all,  there  is  nothing  to  be  mourning  over.  The 
Institution  did  good  service  for  many  years  ;  it  set  the 
standard  of  research  work,  and  it  has  only  given  place  to 
larger  and  wealthier  institutions. 

For  his  own  share  of  the  work,  Horsley  followed  three 
main  hnes  of  research.  He  studied  (i)  The  localisation  of 
function  in  the  brain,  and  the  pathology  of  epilepsy  and  of 
canine  chorea.  (2)  The  thyroid  gland  ;  with  special  refer- 
ence to  myxoedema  and  cretinism.  (3)  The  protective 
treatment  against  rabies  (hydrophobia).  His  work  on  the 
thyroid  gland,  and  on  rabies,  was  all,  or  nearly  all  of  it,  at 
the  Institution  ;  and  was  done  as  it  were  single-handed. 
His  work  on  the  localisation  of  function  in  the  brain  was  in 
part  at  the  Institution,  in  part  elsewhere ;  and  was  done  in 
co-operation  with  other  men. 

What  he  did  for  the  cure  of  myxoedema,  and  what  he  did 
for  the  stamping-out  of  rabies,  come  first  to  be  described ; 
for  they  can  be  isolated  from  the  record  of  his  work  for 
surgery.  What  he  did  for  the  localisation  of  function  in 
the  brain  cannot  be  thus  isolated  ;  it  is  therefore  put  last, 
so  that  the  record  of  his  work  for  surgery  may  be  taken  up 
immediately  after  it. 


V 

The  Cure  of  Myxcedema 

I 

On  October  24,  1873,  at  a  meeting  of  the  Clinical  Society 
of  London,  Sir  William  Gull  read  a  paper  '  On  a  cretinoid 
state  supervening  in  adult  life  in  women.'  This  famous  little 
paper,  the  first  description  of  myxcedema,  is  only  five  pages 
long,  and  is  concerned  with  five  cases,  which  he  had  observed 
in  his  private  practice.  Two  of  them  he  described  minutely : 
the  other  three  he  had  seen,  but  had  not  closely  studied. 
All  these  five  patients  were  women.  He  was  careful  not  to 
assert  that  the  condition  was  peculiar  to  women  :  but  the  title 
of  his  paper  gave  a  bias  in  that  direction.  In  his  description 
of  the  likeness  of  these  cases  —  when  the  condition  is  far 
advanced — to  cases  of  cretinism,  he  referred  to  the  papers  by 
Curling  and  by  Hilton  Fagge  on  sporadic  cretinism,  i.e. 
cretinism  as  it  occurs  in  this  country,  a  case  here  and  a  case 
there.  Curling  and  Fagge  had  noted  that  in  cases  of  sporadic 
cretinism  which  they  had  studied  the  thyroid  gland  was 
'  atrophied,'  or  was  even  '  absent.'  In  Gull's  ceises,  it  was 
certainly  not  enlarged  ;  but  he  could  not  be  sure  of  more 
than  that.  He  described  his  cases  admirably:  but  the  con- 
dition was  new  to  him,  and  he  did  not  attempt  to  explain  it  : 

It  will  be  noticed  that  I  have  designated  this  state  cretinoid. 
My  remarks  arc  rather  tentative  than  dogmatical,  my  hope 
being  that  once  the  attention  of  the  profession  is  called  to 
these  cases,  our  clinical  knowledge  of  tliem  will  in  proportion 
improve.  That  tlie  state  is  a  substantive  and  definite  one, 
no  one  will  doubt  wiio  has  had  fair  opportunity  of  obser/ing 
it.  And  that  it  is  allied  to  the  cretin  state  would  appear 
from  the  form  of  the  features,  the  changes  in  the  lips  and 
tongue,  the  character  of  the  hands,  the  alteration  in  the 


9    H 


o    = 


X     t 
2^ 


THE  CURE  OF  MYXCEDEMA  55 

conditions  of  locomotion,  and  the  peculiarities,  though  slight, 
of  the  mental  state  ;  for,  although  the  mind  may  be  clear 
and  the  intellect  unimpaired,  the  temper  is  changed. 

Four  years  later,  on  October  23,  1877,  at  a  meeting  of  the 
Royal  Medical  and  Chirurgical  Society,  Dr.  Ord's  paper  was 
read,  '  On  Myxcedema  :  a  term  proposed  to  be  applied  to  an 
essential  condition  in  the  "  cretinoid  "  affection  occasionally 
observed  in  middle-aged  women.'  Like  Gull,  he  had  seen  five 
cases :  all  of  them  women  :  it  is  possible  that  one  or  even  two 
of  them  were  the  same  that  Gull  had  seen.  Two  of  them  had 
been  under  Ord's  observation  up  to  the  time  of  death  ;  and, 
in  one  of  these,  leave  had  been  granted  for  a  post-fnortem 
examination.  He  thus  proved  that  the  thickening  of  the 
subcutaneous  tissue,  and  of  other  connective  tissues,  was 
due  not  to  any  sort  of  '  dropsy,'  but  to  the  excessive  forma- 
tion of  a  gelatinous  or  mucinoid  substance.  He  therefore 
gave  to  the  disease  its  name,  myxcedema,  i.e.  swelling  due 
to  mucin.  He  noted  that  the  thyroid  gland  was  markedly 
diminished  in  all  his  cases  ;  indeed,  in  the  case  examined 
post  mortem,  it  was  *  practically  annihilated ' :  but  he  took 
this  to  be  merely  the  result  of  shrinkage,  due  to  compression 
of  the  gland  by  excess  of  mucinoid  substance  in  the  inter- 
stices of  its  connective  tissue.  He  referred,  of  course,  to 
Curling,  Fagge,  and  Gull ;  but  the  real  value  of  his  paper 
was  not  in  its  theorising,  but  in  its  exact  evidence  as  to  the 
microscopical  and  chemical  changes  in  the  connective 
tissues. 

During  the  next  few  years,  cases  of  myxcedema  were 
observed  and  published,  by  Charcot  and  others  :  and  its 
occurrence  in  men  came  to  be  recognised. 

Up  to  1882,  all  that  was  known  about  the  thyroid  gland 
more  hindered  than  helped  the  study  of  the  disease.  Cre- 
tinism was  associated,  in  some  cases,  with  diminution  of  the 
thyroid  gland  :  in  others,  with  that  huge  enlargement  of  the 
thyroid  gland  which  is  called  goitre  :  in  others,  the  gland  was 
neither  notably  diminished  nor  notably  enlarged.  Endemic 
cretinism,  i.e.  cretinism  permanently  settled  among  a  people 
— as  in  some  parts  of  SwitzerL-md — certainly  had  some 
association  with  goitre  ;  not  all  Swiss  cretins  were  goitrous. 


56  SIR  VICTOR  HORSLEY 

but  many  were  :  some  more,  some  less.  On  the  other  hand, 
sporadic  cretinism  did  not  seem  to  be  in  any  way  associated 
with  goitre  :  indeed,  Curhng  long  ago  had  emphasised  the 
fact  that  in  his  cases  of  sporadic  cretinism  the  thyroid 
gland  was  atrophied,  if  not  '  absent ' :  and  Fagge  had  even 
gone  so  far  as  to  suggest  that  the  atrophy  of  the  gland  might 
be  the  cause,  or  one  cause,  of  sporadic  cretinism,  and  that 
goitre  might  be,  on  the  whole,  more  antagonistic  than  favour- 
able to  endemic  cretinism.  In  myxoedema  the  gland  was 
'  diminished  ' ;  but  that  might  be  a  result  of  the  disease. 
Besides,  the  gland  can  only  just  be  felt  in  the  neck.  Let  the 
reader  try  to  feel  his  or  her  own  :  it  cannot  be  accurately 
measured :  it  can  only  just  be  felt. 

The  problem  was  insoluble,  for  this  reason,  that  nobody 
knew  what  the  thyroid  gland  was  for.  Men  hesitated  even 
to  call  it  a  gland  :  they  called  it  the  thyroid  body.  It  had 
no  duct :  it  made  no  visible  contribution  to  the  maintenance 
of  the  general  health.  Its  anatomical  relations,  blood  supply, 
and  microscopic  structure,  had  been  studied  to  a  finish. 
Every  medical  student  knew  that  its  acini,  its  ultimate  sub- 
divisions, were  lined  with  glandular  epithelium,  and  con- 
tained a  colloid  or  mucinoid  substance  :  its  lymphatic  spaces 
also  contained  this  substance.  There  were  networks  of 
capillary  blood-vessels  round  the  acini  ;  and  the  look  of  a 
microscope-section  of  the  gland  suggested  that  the  contents 
of  the  acini  were  obtained  from  the  blood  by  the  epithehum 
lining  the  acini,  and  were  re-absorbed  into  the  blood  through 
the  lymphatic  spaces.  But  the  actual  work  and  office  of  the 
gland,  its  administrative  purpose  in  the  economy  of  the  body, 
were  unknown,  even  to  that  great  master  of  physiology, 
Claude  Bernard :  who  writes  in  his  Physiologic  Op^ratoire 
— the  1879  edition,  pubhshed  in  the  year  after  his  death  : 

The  descriptive  anatomy,  and  the  microscopical  character 
of  the  thyroid  gland,  the  facts  about  its  bloodvessels  and  its 
lymphatics — are  not  these  as  well  known  in  the  thyroid  gland 
as  in  other  organs  ?  Is  not  this  true  also  of  the  thymus 
gland,  and  the  suprarenal  capsules  ?  Yet  we  know  absolutely 
nothing  about  the  functions  of  these  organs  :  we  have  not 
so  much  as  an  idea  of  what  use  and  importance  they  may 
possess:  because  experiments  have  told  us  nothing  about 


THE  CURE  OF  MYXCEDEMA  57 

them  :  and  anatomy,  left  to  itself,  is  absolutely  silent  on  the 
subject. 

In  1882-83,  the  problem  was  brought  nearer  to  solution  by 
a  set  of  facts  as  unexpected  as  they  were  unwelcome.  It 
was  found  that  many  experiments  had  indeed  been  recently 
made  on  the  thyroid  gland  ;  but  they  had  been  made  not  on 
animals  but  on  man.  The  antiseptic  method  had  so  advanced 
surgery  that  some  of  the  Swiss  surgeons  had  been  dealing 
with  goitre  by  the  removal  of  it  en  masse.  Some  of  these 
patients,  at  various  intervals  after  the  operation,  had  shown 
signs  resembling  those  which  had  been  observed,  in  England, 
in  cases  of  myxoedema 

The  earliest  description  of  these  Swiss  cases  was  given  by 
Professor  Reverdin,  of  Geneva,  on  September  13,  1882,  at 
a  meeting  of  the  Geneva  Medical  Society.  He  and  Professor 
Kocher,  of  Berne,  a  few  days  before,  had  been  talking  over 
these  '  accidents  g^n^raux  tardifs,'  as  Reverdin  called  them  ; 
but  had  come  to  no  conclusion  about  them  :  indeed  Reverdin, 
at  this  time,  had  only  had  one  case  under  his  own  observa- 
tion. He  was  of  opinion,  in  September  1882,  that  the 
condition  might  be  due  either  to  the  loss  of  some  '  blood- 
making  function  '  of  the  gland,  or  to  some  injury  done  by 
the  operation  to  the  nerves  in  the  neighbourhood  of  the 
gland.  A  short  note  on  this  meeting  of  the  Geneva  Medical 
Society  was  published  in  the  Revue  de  la  Suisse  Romande. 

On  April  4,  1883,  at  the  Twelfth  Congress  of  the  German 
Surgical  Association,  Kocher  gave  an  address  '  On  the 
extirpation  of  goitre,  and  its  consequences.'  It  was  pub- 
lished in  Langenbeck's  Archiv.  He  suggested,  for  these 
cases,  the  name  '  cachexia  strumipriva,'  i.e.  ill-health  from 
loss  of  the  thyroid  gland.  Like  Reverdin,  he  did  not  see 
their  full  significance  :  he  was  inclined,  on  the  whole,  to 
think  that  the  operation  had  somehow  affected  the  trachea, 
and  thus  had  interfered  with  the  free  exchange  of  the  air 
in  the  lungs  and  impaired  the  nutrition  of  the  tissues. 

During  April- June  1883,  Professor  Reverdin  and  Auguste 
Reverdin  published  in  the  Rovue  de  la  Suisse  Romande  their 
'  Note  sur  vingt-deux  opcTations  de  goitre."  They  had  by 
this  time  learned  of  the  English  cases  of  myxoedema,  from 


58  SIR  VICTOR  HORSLEY 

one  of  Dr.  W.  B.  Hadden's  writings.  They  now  recognised 
the  more  than  likeness,  the  '  rapprochement  complet,' 
between  the  EngUsh  cases  of  myxoedema  and  their  own  cases 
of  '  myxced^me  operatoire  ' ;  and  they  were  convinced  that 
the  sohition  of  the  problem  Wcis  to  be  found  in  the  thyroid 
gland,  and  nowhere  else.  But  they  were  inclined  to  think 
that  '  myxoed^me  operatoire  '  was  due  rather  to  the  loss  of 
the  gland's  nerve-influences  than  to  the  loss  of  its  chemical 
influences  : 

Si  nous  tenons  compte  de  ces  fails,  de  I'existence  ^vidente 
de  troubles  vaso-moteurs  dans  nos  cas,  comme  dans  ceux 
dc  myxoedeme,  nous  sommes  amends  k  faire  jouer  un  r61e 
preponderant  aux  alterations  nerveuses  dans  la  pathogenie 
de  ces  accidents,  et  k  en  placer  le  point  de  depart  dans  les 
parties  nerveuses  de  la  thyroide. 

On  November  23, 1883,  at  a  meeting  of  the  Clinical  Society 
of  London,  there  was  a  discussion  over  a  case  of  myxoedema 
shown  by  Dr.  Drewitt ;  and  Sir  Felix  Semon  called  attention 
to  Kocher's  observations,  and  said  positively  that  cretinism, 
myxoedema,  and  cachexia  strumipriva,  were  closely  aUied 
conditions,  having  in  common  either  absence  or  probably 
complete  degeneration  of  the  thyroid  gland  ;  and  that  they 
could  hardly  be  attributed  to  any  other  cause.  On  December 
14,  the  Clinical  Society  appointed  a  Committee  to  mvesti- 
gate  the  whole  subject.  Ord  was  Chairman,  Hadden  was 
Hon.  Secretary,  and  Horsley  was  a  member  of  the  Committee. 

It  was  of  necessity,  that  the  investigation  should  include 
the  experimental  study  of  the  healthy  gland  in  healthy 
animals.  Nothing  more  was  to  be  gained  by  theorising  over 
cases.  The  Committee  had  the  evidence  of  cachexia 
strumipriva  to  guide  them  ;  but  they  could  not  found  any 
exact  knowledge  of  the  healthy  gland  on  this  half-knowledge 
of  the  grossly  diseased  gland.  Some  cretins  were  goitrous  : 
some  were  not.  Some  operations  for  the  removal  of  goitre 
had  been  followed  by  cachexia  strumipriva  :  some  had  not. 
Goitre  was  a  great  mass  of  ill-formed  connective  tissue, 
with  remnants  of  thyroid  gland  surviving  here  and  there  in 
it :  the  working  power  of  the  gland  was  more  or  less  de- 
stroyed :  but  nobody  knew  what  that  working  power  was. 


THE  CURE  OF  MYXOEDEMA  59 

Till  they  knew  what  the  healthy  gland  was  actually  doing, 
what  it  really  was  for,  the  Committee  might  investigate  any 
number  of  cases  without  being  much  the  wiser.  Anatomy, 
and  the  microscope,  had  told  them  nothing,  or  next  to 
nothing.  Clinical  observation,  and  post-ttioriem  observation, 
and  the  facts  of  cachexia  strumipriva,  had  given  them,  after 
ten  years,  a  good  working  theory.  In  the  light  of  that 
theory,  slowly  attained  at  the  expense  of  mankind,  they 
must  begin  at  the  beginning,  with  the  healthy  gland  ;  and 
the  pity  is,  that  they  did  not  begin  sooner.  Now,  in  1883-84, 
at  last,  recognising  '  the  hitherto  undreamt-of  importance  of 
the  thyroid  gland,'  they  asked  Horsley  to  study  it  by  the 
experimental  method.  They  needed  a  physiologist,  and  a 
surgeon  :  and  they  had  them  in  him. 

II 

He  began  this  work  in  the  autumn  of  1884,  in  Professor 
Schafer's  laboratory  :  and  he  continued  it  at  the  Brown 
Institution.  He  writes  to  Professor  Schafer  of  his  first 
experiments  :  in  these,  he  had  the  help  of  another  member 
of  the  Committee,  Mr.  (Sir  Rickman)  Godlee.  The  letter  is 
undated  :  a  very  rare  omission  with  him  :  it  must  have 
been  written  about  October  1884  : 

I  have  started  some  experiments  with  Godlee  on  the 
thyroid  body.  Schiff  published  some  papers  lately  on  the 
removal  of  the  said  organ  in  dogs  and  rodents,  etc.,  finding 
that  the  animals  all  died  and  usually  with  nerve  symptoms 
such  as  tremors,  etc.  Well,  we  did  four  monkeys  last  week, 
and  one  of  them  has  the  said  tremors  very  badly.  I  have 
taken  a  tracing,  it  looks  just  like  ankle-clonus.  .  .  . 

In  December,  at  the  University  of  London,  he  gave  two 
lectures,  '  The  Thyroid  Gland  :  its  relation  to  the  pathology 
of  myxoedema  and  cretinism,  to  the  question  of  the  surgical 
treatment  of  goitre,  and  to  the  general  nutrition  of  the 
body.'  There  is  something  characteristic  of  him  in  this 
comprehensive  title.  Up  to  1884,  there  had  not  been,  in 
any  country,  much  study  of  the  thyroid  gland  by  the  ex- 
perimental method  ;  and,  in  our  coimtry,  there  had  been 
next  to  none.     The  few  experiments  which  had  been  made 


6o  SIR  VICTOR  HORSLEY 

over  here  had  been  valueless  ;  partly  for  want  of  the  anti- 
septic method,  partly  because  the  men  who  made  them 
had  not  known  what  to  look  for  :  they  had  not  solved 
any  problem,  because  no  problem  had  been  set  to  them. 
Myxoedema  set  the  problem  :  later,  cachexia  strumipriva 
set  it  in  more  definite  terms.  And  Horsley,  so  far  as  this 
country  is  concerned,  did  more  than  any  man  to  solve  it. 

His  decision,  at  the  very  beginning  of  his  work,  to  make 
use  of  monkeys,  is  a  good  example  of  the  value  of  the 
imagination  in  science.  Not  that  his  experiments  on  dogs 
and  cats  were  in  any  way  contradictory  to  his  experiments 
on  monkeys.  He  got  positive  and  final  evidence,  alike  in 
camivora  and  in  monkeys,  that  cachexia  strumipriva  was 
due  neither  to  an}^  sort  of  interference  with  the  aeration  of 
the  blood,  nor  to  any  sort  of  injury  to  the  adjacent  nerves, 
but  to  loss  of  the  thyroid  gland,  and  to  that  alone.  But 
there  were  well-marked  differences,  in  the  incidence  and 
intensity  of  the  results  of  complete  removal  of  the  gland, 
between  the  animals  less  like  man  and  the  animals  most 
like  man.  In  the  dog,  the  results  came  rapidly,  and  were 
soon  fatal :  in  the  monkey,  they  showed  themselves  more 
gradually,  and  made  a  more  complete  picture.  If  the 
phrase  may  be  pardoned,  he  produced  in  dogs  a  condition 
which  men  of  science  could  accept  as  evidence :  but  he 
produced  in  monkeys  a  condition  which  the  man  in  the 
street  could  accept  as  evidence. 

And  though  he  was  unwilling,  at  this  stage  of  his  work,  to 
deny  point-blank  the  possibihty  that  the  results  of  the  re- 
moval of  the  gland  might  come,  not  directly  from  the  loss  of 
its  chemical  influences,  but  indirectly  from  the  loss  of  its 
influences  over  the  vaso-motor  and  trophic  nerves,  yet  he 
was  already  beginning  to  see  the  whole  thing  as  a  chemical 
process.  '  The  question  arises,'  he  says,  '  whether  we  have 
not  to  do  with  the  simple  case  of  total  removal  of  an  excretory 
organ,  with  the  usual  result  of  death.' 

His  description  of  the  monkeys  must  be  given  in  his  own 
words  : 

The  phenomena  which  follow  thyroidectomy  in  monkeys 
^re  very  striking,  and  may  be  sunimarised  as  follows.     At 


THE  CURE  OF  MYXCEDEMA  6i 

a  variable  period  after  the  operation,  but  averaging  about 
five  days,  tlie  animal  is  found  to  have  lost  its  appetite  for 
a  day  or  two,  and,  on  closer  examination,  to  exhibit  slight 
constant  fibrillar  tremor  in  the  muscles,  of  the  face  and  hands 
and  feet  more  especially.  These  tremors  disappear  at  once 
on  voluntary  effort.  At  the  same  time,  the  animal  is  noticed 
to  be  growing  pale  and  thin,  in  spite  of  the  appetite  returning 
quickly  with  great  increase  ;  rapidly  the  tremors  increase, 
affect  all  the  muscles  of  the  body  without  exception  ;  the 
animal  becomes  languid,  paretic  in  its  movements,  and 
imbecile.  Then  puffiness  of  the  eyelids  and  swelling  of  the 
abdomen  follow,  with  increasing  hebetude.  During  these 
last  stages,  the  temperature,  gradually  falling,  becomes 
subnormal ;  and  then  tiie  tremors  gradually  disappear  as 
they  came.  Meanwhile,  the  pallor  of  the  skin  often  becomes 
intense  ;  and,  leucocytosis  having  been  well  marked,  ohgaemia 
follows,  and  the  animal  dies  perfectly  comatose  in  a  variable 
period,  but  usually  about  five  or  seven  weeks  after  the 
operation. 

In  these  lectures — which  he  illustrated  with  photographs, 
pulse  -  tracings,  etc.  —  he  compared,  point  by  point,  the 
symptoms  produced  in  animals  with  the  symptoms  of  cretin- 
ism, myxcedema,  and  cachexia  strumipriva  in  man.  He 
emphasised  the  importance  of  the  chemical  analyses  made 
by  Professor  HaUiburton.  The  monkeys  showed  not  only 
a  great  increase  of  mucin  in  the  connective  tissues,  and  a 
trace  of  mucin  in  the  blood,  but  a  very  great  increase  of 
mucin  in  the  saliva.  There  was  also  marked  enlargement 
of  the  parotid  salivary  glands. 

He  referred,  in  these  lectures,  to  the  work  that  was  being 
done  in  Switzerland,  Austria,  and  Italy  ;  especially  to  Schiff 's 
papers,  published  in  the  Revue  de  la  Suisse  Romande,  Feb- 
ruary and  August  1884.  But  he  did  not  refer  to  the  one 
set  of  Schiff 's  experiments  which  was  far  and  away  the  most 
important  of  all.  He  had  not  verified  them  for  himself  ; 
he  could  hardly  take  it  for  granted  that  they  were  authori- 
tative ;  and  he  w^as  working  on  his  own  lines.  Schiff  had 
found  that  an  animal  could  be  safeguarded  against  some  ol 
the  consequences  of  thyroidectomy,  by  transplantation  of  a 
thyroid  gland  from  another  animal  of  the  same  species.  The 
engrafted  gland  compensated  the  animal,  more  or  less,  for 
the  loss  of  its  own  gland  : 


62  SIR  VICTOR  HORSLEY 

La  thyroidectomie  perd  ses  dangers  et  une  partie  essentielle 
de  ses  eifets  si  Ton  a  introduit  et  &xe  d'abord  dans  la  cavite 
abdominale  d'autres  corps  thyroldes  de  la  merae  espece 
animale. 

Then  comes  a  sentence  which  is  even  more  remarkable  : 
'  It  would  be  interesting  to  know  whether  an  emulsion  of 
thyroid  gland  would  not  have  an  analogous  effect ' : 

II  serait  int^ressant  de  savoir  si  des  glandes  thyroides 
broy^es  ou  ecrasees,  introduites  dans  une  cavite  du  corps  ou 
sous  forme  de  clystere  par  Ic  rectum,  n'auraient  pas  un  effet 
analogue.  Les  conditions  de  notre  laboratoire  ne  nous  ont 
pas  pcrmis  de  faire  ccs  experiences,  qui  pourraient  offrir  un 
interet  pratique.  On  devrait  d'abord  examiner  si  les  thyroides 
de  nos  ruminants  ont  sur  le  chien  le  meme  effet  que  les 
thyroides  canines. 

Here,  in  print,  in  1884,  was  a  clear  indication  of  the  way  to 
cure  myxoedema :  and  it  is  hard  to  miderstand  why  Horsley 
did  not  immediately  follow  it  up  for  all  it  was  worth. 

In  1885,  he  extended  and  confirmed  his  work  of  the  pre- 
vious year  :  he  made  two  experiments  on  sheep,  and  one  on 
a  donkey  :  but  especially,  this  year,  he  studied  the  effects  of 
removal  of  the  gland,  in  relation  (i)  to  the  age  of  the  animal, 
(2)  to  the  temperature  in  which  the  animal  was  kept  after 
the  operation.  On  these  two  very  important  subjects  he 
writes  as  follows,  in  his  Report  for  1885  to  the  Committee 
of  the  Brown  Institution  : 

(i)  The  effect  of  removing  the  gland  in  the  young  animal 
is  the  rapid  appearance  of  violent  nerve  symptoms,  and  death 
in  a  few  days  ;  in  a  rather  older  animal,  i.e.  a  one-year-old 
dog,  the  symptoms  are  less  violent,  later  in  their  appearance, 
and  the  animal  survives  perhaps  for  a  fortnight  or  three 
weeks ;  in  a  very  old  animal  the  removal  of  the  gland  simply 
hastens  the  torpor  of  old  age  ;  these  observations  refer  to 
dogs  and  cats.  In  the  higher  animals,  monkeys,  the  opera- 
tion on  a  young  individual  produces  the  same  result  as  in  a 
young  dog ;  but,  as  I  showed  last  year,  an  older  animal,  if 
kept  under  ordinary  circumstances,  will  survive  for  six  or 
seven  weeks,  dying  at  the  end  of  that  time  of  myxoedema. 
...  I  desire  here  to  draw  special  attention  to  the  fact  that 
the  symptoms  of  old  age,  namely,  wasting  of  the  actively 
functional  parenchymatous  tissues,  atropliy,  and  falling  out 
of  the  hair,  decay  of  the  teeth,  dryness  and  harshness  of  the 
skin,  tremors,  etc.,  are  exactly  the  most  prominent  features 


THE  CURE  OF  MYXCEDEMA  63 

of  the  myxoederaatous  state,  whether  it  occurs  naturally  in 
the  human  being,  prematurely  as  in  cretinism,  or  artificially 
as  in  my  experiments  on  monkeys. 

(2)  I  have  kept  another  series  of  animals,  on  whom  I  have 
performed  thyroidectomy,  at  a  constant  temperature  of 
90°  F.,  and  when  they  exhibited  any  nerve-symptoms, 
i.e.  tremors,  etc.,  placed  them  in  a  hot-air  bath  at  a  tempera- 
ture of  105°  F.  The  effect  of  this  has  been  to  lengthen  the 
duration  of  life  (in  all  but  very  young  animals)  to  four  or 
five  times  the  extent  of  that  observed  in  the  first  series. 
Instead  of  living  four  to  seven  weeks  they  now  live  as  many 
months.  These  observations  refer  solely  to  monkeys.  The 
animals  pass  through  three  stages  :  (i)  neurotic,  (2)  mucinoid. 
(3)  atrophic.  The  neurotic  stage  may  be  scarcely  marked : 
or,  if  the  nerve-symptoms  occur,  and  the  animal  be  put  in 
the  hot-air  bath,  they  soon  disappear.  Next,  the  animal 
lives  through  the  mucinoid  stage,  i.e.  myxcedematous  con- 
dition ;  and  arrives  in  the  third  stage,  the  atrophic.  The 
symptoms  of  the  second  stage  are  just  as  much  subdued  as 
those  of  the  first  :  there  is  no  excessive  secretion  of  mucus, 
the  parotid  glands  do  not  swell,  and  the  post-mortem  examina- 
tion does  not  reveal  the  extensive  mucinoid  degeneration 
observed  in  the  first  series.  Finally,  the  third,  atrophic, 
stage  into  which  the  animal  passes  is  evidenced  by  great 
emaciation,  functional  paresis  and  paralysis,  imbecihty, 
falling  blood-pressure  and  temperature,  with  death  by  coma. 

I  am  disposed  to  regard  this  fact  of  the  animals  passing 
these  neurotic,  mucinoid  stages,  and  dying  at  the  end  of  the 
atrophic,  as  the  key  to  the  observation  that  cretins  in  whom 
the  thyroid  gland  is  very  slowly  destroyed,  and  very  chronic 
cases  of  myxoedema,  do  not  exhibit  much  mucinoid 
degeneration. 

In  1886,  he  examined,  and  disproved,  two  theories — one 
old,  one  new — of  the  thyroid  gland  :  (i)  That  its  right  and  left 
lobes  were  somehow  related  to  the  circulation  through  the 
right  and  left  hemispheres  of  the  brain.  (2)  That  its  activity 
was  regulated  by  the  recurrent  laryngeal  nerve.  After  1886, 
he  began  to  be  more  occupied  with  otiier  studies,  and  less 
with  the  experimental  study  of  the  thyroid  gland. 

In  1888,  the  Investigation  Committee  of  th(>  Clinical 
Society  publislK.'d  their  long-exix^cted  Re|>ort  on  Myxoedema. 
It  is  215  pages  long  :  it  includes  reports  from  Halliburton. 
Horsley,  Semon,  and  Ord  ;  and  it  gives  tables  of  109  ca.ses. 
each  case  divided  under  no  less  than  eighty-eight  headings. 
There  could  hardly  be  a  better  example  of  thoroughness  ;  and 


64  SIR  VICTOR  HORSLEY 

it  was  everywhere  accepted  as  of  authority.  Its  conclusions 
were — That  the  one  condition  common  to  all  cases  of  myxoe- 
dema  was  destructive  change  of  the  thyroid  gland.  That 
the  apparent  immunity  of  some  patients  from  cachexia 
strumipriva,  after  removal  of  goitre,  might  be  explained 
either  by  the  presence  of  accessory  thyroid-tissue,  or  by 
accidentally  incomplete  removal,  or  by  insufficiently  long 
observation  of  this  or  that  case.  That  myxoedema  was 
'  practically  the  same  disease  '  as  sporadic  cretinism,  was 
'  probably  identical  with  '  cachexia  strumipriva,  and  was  in 
'  very  close  affinity  '  with  endemic  cretinism. 

But  the  Report  contained  not  a  word  of  hope  of  any  cure 
of  the  disease.  It  gave  to  treatment,  out  of  215  pages, 
one.  A  warm  room,  a  warm  climate,  tonics,  drugs  to  make 
the  skin  act,  and  nitro-glycerin  to  make  everything  else  act 
— and  there  the  hst  ends,  and  might  as  well  not  have  begun. 
It  recalls  Dr.  Scarbrugh's  phrase  for  the  eleven  physicians 
round  the  deathbed  of  King  Charles  the  Second — toins  medi- 
corum  chorus  ab  otnni  spe  dcstihUus. 

Ill 

Finally,  on  February  8,  1890,  Horsley  published  in  the 
British  Medical  Journal  his  '  Note  on  a  possible  means  of 
arresting  the  progress  of  myxoedema,  cachexia  strumipriva, 
and  alHed  diseases.'  He  harks  back  to  Schiff's  transplanta- 
tion experiments,  and  to  similar  experiments  by  von 
Eisselsberg  : 

It  seems  to  me  that  these  observations,  of  Professor  Schiff 
and  of  Dr.  von  Eisselsberg,  are  of  especial  value,  as  they 
suggest  to  my  mind  that  possibly  myxoedema,  etc.,  may  be 
treated  with  success  by  transplanting  thyroid  tissue  into  the 
patient.  ...  I  would  propose,  therefore,  when  opportunity 
offers,  to  try  transplanting  a  portion  of  the  thyroid  gland 
from  a  sheep. 

He  learned  afterwards  that  Dr.  Bircher  of  Aarau,  on 
January  16,  1889,  had  practised  this  method  in  one  case, 
and  that  Kocher  also  had  practised  it,  in  one  case,  in  1883, 
without  success,  and  in  a  few  cases,  in  1889,  with  one  success. 

Here  at  last  was  the  specific  treatment  of  myxoedema. 


THE  CURE  OF  MYXCEDEMA  65 

Not  that  the  transplantation  treatment  was  perfect  :  for  in 
some  cases  the  transplanted  tissue  gradually  became  ab- 
sorbed, and  thus  ceased  to  be  efficient.  But  here  was  the 
first  rational  way  of  dealing  with  the  disease  :  and,  for  certain 
cases,  Horsley  was  still  in  favour  of  it,  so  late  as  iqi2. 

Last  of  all,  in  July  1891,  at  the  Bournemouth  meeting  of 
the  British  Medical  Association,  Dr.  George  ^lurray  of  New- 
castle, now  Professor  of  Medicine  in  the  University  of  Man- 
chester, read  his  paper,  '  On  the  treatment  of  myxoedema  by 
hypodermic  injection  of  an  extract  of  the  thyroid  gland  of  a 
sheep.'  He  refers  to  a  very  successful  case  of  transplanta- 
tion, published  by  Bettencourt  and  Serrano,  of  Lisbon  : 
then  he  says  : 

It  seems  reasonable  to  suppose  that  the  same  amount  of 
improvement  might  be  obtained  by  simply  injecting  the 
juice  or  an  extract  of  the  thyroid  gland  of  a  sheep  beneath 
the  skin  of  the  patient. 

If  we  consider  that  myxoedema  and  cachexia  strumipriva 
are  due  to  the  absence  from  the  body  of  some  substance 
which  is  present  in  the  normal  thyroid  gland,  and  which  is 
necessary  to  maintain  the  body  in  health,  it  is  at  least  rational 
treatment  to  supply  that  deficiency  as  far  as  possible  by 
injecting  the  extract  of  a  healthy  gland.  G.  Vessale  has 
made  intravenous  injections  of  an  extract  of  the  thyroid 
gland  in  dogs  after  thyroidectomy  with  beneficial  results. 
As  far  as  I  am  aware,  this  means  of  treatment  has  not  before 
been  tried  in  the  human  subject.  Since  suggesting  this 
treatment  at  the  February  meeting  of  the  Northumberland 
and  Durham  Medical  Society,  I  have  been  able  to  carry  it 
out  in  a  well-marked  case  of  myxoedema.  Such  decided 
improvement  has  resulted  that  the  details  of  the  method  of 
treatment  employed  and  the  results  obtained  are  worth 
recording. 

He  and  Horsley  had  of  course  been  in  correspondence 
over  this  plan  of  treatment :  there  are  two  letters  from 
Horsley  to  him  :  ^ 

Dec.  3,  1890.     The  only  experiments  I  know  of  on  injec- 
tions of  the  gland  have  only  j)roduccd  slight  results,  similar 

*  Professor  Murray  has  written  :  '  I  first  met  Horsley  when  I  was  a 
student  and  house  physician  at  University  College  Hospital,  from  1886 
to  1889.  I  attended  his  course  of  practical  pathology,  and  his  outpatient 
practice.  He  gave  me  some  very  Jiscful  introductions  when  I  went  to 
BerUn  in  1889.  Our  friendship  really  began  after  I  had  settled  in  New- 
castle in  1890.     Ever  since  then,  our  friendship  has  continued,  and  bo 

E 


66  SIR  VICTOR  IIORSLEY 

90  far  as  I  could  see  to  what  might  have  been  caused  by 
injections  from  any  other  tissue.  However,  it  cannot  do  any 
harm,  and  I  think  it  would  be  worth  trying,  as  it  is  possible 
from  Schiff's  results  of  imperfect  transplantation  that  an 
emulsion  of  the  gland  might  possess  some  of  its  active 
properties. 

June  22,  1891.  I  am  ashamed  to  have  kept  you  so  long, 
but  I  wanted  to  re-verify  one  reference,  and  I  have  been 
absolutely  unable,  principally  in  consequence  of  inauguration 
of  a  family,  to  visit  the  Hbrary  before  to-day.  I  am  very 
glad  to  say  that  the  reference  only  contains  a  suggestion,  not 
the  actual  practice.  In  that,  you  have  only  been  forestalled 
experimentally.  Thus,  Vessale  (Centralblatt  fiir  Medicinische 
Wissenschaften,  1891,  p.  14)  injected  the  expressed  juice  of 
the  thyroid  into  dogs  in  which  thyroidectomy  had  previously 
been  performed,  and  he  found  that  the  cachectic  symptoms 
did  not  occur  or,  if  they  did,  were  considerably  modified. 
The  clinical  reference  is  as  follows — Bettencourt  and  Serrano 
(Progres  Medical,  1890,  vol.  xii.  p.  170).  These  authors, 
who  had  adopted  the  suggestion  of  grafting  the  thyroid, 
suggest  that  the  benefits  obtained  therefrom  are  due  to 
absorption  of  material  from  the  gland,  and  the  same  idea 
had  occurred  to  Schiff  and  others.  Hoping  this  is  not  too 
late  for  your  wants,  and  that  you  will  publish  at  once, — I 
am  yours  very  sincerely. 

Murray's  paper  was  published  in  the  British  Medical 
Journal,  October  10,  1891  ;  with  a  note  by  Mr.  E.  H. 
Fenwick  on  a  similar  case. 

Early  in  1892,  Horsley  published  his  '  Remarks  on  the 
Function  of  the  Thyroid  Gland  :  a  critical  and  historical 
review.'  (Brit.  Med.  Journ.,  January  30  and  February  6, 
1892.)  He  had  already  published  this  review,  in  German, 
in  Virchow's  Festschrift,  1891. 

There  was  still  one  great  improvement  to  be  made  in  the 
treatment  of  the  disease  :  it  came  in  October  1892,  when 
Dr.  Hector  Mackenzie  published  his  paper,  '  A  case  of 
myxoedema  treated  with  great  benefit  by  feeding  with  fresh 
thyroid  glands,'  and  Dr.  E.  L.  Fox  of  Plymouth  published 
his  paper,  '  A  case  of  myxoedema  treated  by  taking  extract 

always  gave  me  the  greatest  help  and  encouragement.  I  spent  many 
happy  holidays  with  liim,  as  we  both  were  very  fond  of  shooting.  He 
was  a  most  chaiminp  host,  and  the  life  and  soul  of  the  party.  He  was  one 
of  the  most  unselfisli  men  I  ever  met,  in  both  scientific  and  social  questions  : 
and  was  certainly  the  greatest  member  of  our  profession  in  liis  generation. 
By  his  death  I  have  lost  one  of  my  kindest  and  best  friends.* 


THE  CURE  OF  MYXCEDEMA  67 

of  thyroid  by  the  mouth.'  This  method  had  also  been  used 
by  Dr.  Howitz  of  Copenhagen  :  but  Hector  Mackenzie  and 
Fox  discovered  it  independently  of  him.  Their  papers  were 
published  in  the  British  Medical  Journal,  October  29,  1892. 
During  the  next  few  months,  little  culinary  devices  were 
invented  to  make  the  dose  palatable,  till  the  manufacturing 
chemists  were  able  to  supply  the  preparations  of  thyroid 
gland  which  are  now  in  use.  With  these,  men  and  women 
whose  thyroids  fail  them  can  take  care  of  themselves  :  they 
can  treat  themselves  when  they  feel  the  need  of  it  ;  they 
can  free  themselves  from  myxoedema  to  the  end  of  their 
lives. 

During  1893,  many  cases  were  put  on  record  ;  many 
patients  were  shown  at  medical  meetings  ;  the  efficacy  of 
the  new  drug  was  proved  over  and  over  again.  One  of  the 
more  notable  cases,  in  1893,  was  a  case  of  sporadic  cretinism, 
treated  by  transplantation,  by  Dr.  Lockhart  Gibson  of 
Brisbane. 

It  is  twenty  years  from  1873  to  1893  :  from  Gull's  observa- 
tion of  '  a  cretinoid  state  supervening  in  adult  hfe  in  women,' 
to  the  general  recognition  of  the  cure  of  myxoedema.  The 
discovery  came  not  from  one  line  of  study  but  from  many. 
Horsley  does  not  stand  alone.  But  it  was  he  who  founded 
in  this  country  the  modem  study  of  the  thyroid  gland  :  and 
it  was  he  who  first,  in  this  country,  suggested  the  rational 
method  of  treatment.  Those  of  his  profession  who  re- 
member the  years  of  ignorance,  and  the  wonder  and  the 
delight  of  the  new  learning,  are  not  likely  to  forget  what  he 
did  in  1884-86  for  science,  and  in  1890  for  practice. 


VI 

The  Prevention  of  Rabies 

His  work  for  the  prevention  of  rabies  (hydrophobia)  was 
ended  and  put  away  when  the  disease,  by  the  enforcement 
of  muzzling  and  by  quarantine  of  dogs,  was  stamped  out 
from  this  country.  Up  to  that  time,  he  was  Pasteur's 
chief  representative  and  interpreter  over  here.  He,  more 
than  anybody,  explained  Pasteur's  method  to  the  British 
public.  It  was  a  position  of  remarkable  authority  for  him, 
and  him  so  young,  to  be  the  one  man  in  the  kingdom  able 
to  say,  by  the  employment  of  Pasteur's  test,  whether  a  dog. 
killed  on  suspicion  of  rabies,  had  or  had  not  been  suffering 
from  the  disease.  Nor  did  his  work  stop  there  :  for  he  also 
saw  many  cases  of  the  disease  in  man  and  animals,  studied 
its  incidence,  examined  and  exposed  a  much-advertised 
'  cure,'  and  fought,  in  the  press  and  on  the  platform,  and  by 
all  ways  of  influence  open  to  him,  till  there  was  nothing  left 
to  fight  for. 

The  story  of  Pasteur's  discovery  of  the  anti-rabic  treat- 
ment has  been  told  many  times,  and  I  need  not  tell  it  here. 
I  remember  him  dining  with  my  father,  Sir  James  Paget,  on 
April  21,  1884 :  Professor  Tyndall,  Lord  Reay,  Lord 
Avebury,  and  Sir  Andrew  Clark  were  of  the  party,  and  over 
the  dessert  Pasteur  described  the  results  which  he  had 
already  obtained  from  the  experimental  study  of  the 
disease  ;  speaking  very  slowly  and  very  gravely,  that  no 
point  should  be  missed.  Horsley  was  not  there,  more  's  the 
pity  :  of  all  the  younger  men,  he  was  the  one  whose  work 
my  father  most  admired,  saying  of  some  of  it  that  it  marked 
an  epoch  in  the  history  of  medicine  :  but  I  remember  him 
dining  at  my  father's  house  in  1887  :  of  course,  he  took 
neither  wine,  nor  a  cigarette  after  dinner,  and  my  father 
looked  across  the  table  at  him,  with  affection  just  touched 

68 


THE  PREVENTION  OF  RABIES  69 

with  resentment  of  the  unusual,  and  said,  '  Haven't  you 
one  vice  ?  '  Horsley  laughed  and  blushed,  and  said,  '  I  'm 
afraid  I  've  got  a  great  many.  Sir  James.' 


THE   COMMISSION   OF   ENQUIRY   INTO   PASTEUR  S   METHOD 

It  was  on  July  6,  1885,  that  Pasteur,  having  proved,  by 
a  very  long  series  of  experiments  and  control-experiments, 
that  he  could  immunise  dogs  against  rabies,  not  only  before 
infection,  but  during  the  latent  period  after  infection, 
ventured  to  treat  his  first  patient.  In  April  1886,  a  Com- 
mission was  appointed  over  here,  by  the  Local  Government 
Board,  to  enquire  into  Pasteur's  method.  The  members 
of  this  Commission  were  Sir  James  Paget,  Chairman  of 
Committee,  Sir  Lauder  Brunton,  Dr.  George  Fleming,  Lord 
Lister,  Sir  Richard  Quain,  Sir  Henry  Roscoe,  and  Sir  John 
Burdon  Sanderson,  with  Horsley  as  Secretary.  There  is  a 
letter  from  Sir  Henry  Roscoe  to  Sir  James  Paget,  April  12, 
1886: 

You  will  see  from  the  enclosed  letters  that  the  Committee 
can  appoint  a  Secretary  with  a  remuneration  of  £50,  and 
also  that  we  are  to  divide  our  enquiry  into  two  parts :  (i)  As 
to  the  evidence  obtainable  in  Paris  relative  to  Pasteur's 
discovery ;  (2)  As  to  further  investigations  which  we  may 
consider  it  necessary,  in  consequence  of  evidence  obtained 
in  Paris,  to  make  in  this  country.  Also  that  we  are  to  report 
to  the  Local  Government  Board  the  results  of  our  first 
enquiry  before  entering  on  our  second.  I  also  enclose  letter 
from  Mr.  Chamberlain,  in  reply  to  a  letter  from  me  enclosing 
your  letter.  From  this  you  will  perceive  that  aU  idea  of 
appointing  a  person  in  favour  with  the  antivivisectionists 
has  very  properly  been  abandoned. 

At  the  first  meeting  of  the  Committee,  on  April  15,  it  was 
agreed  '  that  a  letter  should  be  written  to  M.  Pasteur,  in- 
forming him  of  the  appointment  and  purpose  of  the  Com- 
mission, and  asking  him  to  name  a  day  in  the  next  week  on 
which  he  could  receive  some  of  the  members.'  The  letter 
was  written  by  Sir  James  Paget,  and  was  taken  to  Paris  by 
Burdon  Sanderson  on  April  16.  Brunton,  Roscoe,  and 
Horsley  went  to  Paris  a  few  days  later.     The  £50  did  not. 


70  SIR  VICTOR  HORSLEY 

by  a  long  wav,  cover  Horsley's  expenses  :  but  Sir  Henry 
Roscoe's  generosity  did. 

Pasteur,  this  April,  had  been  suffering  miserable  anxiety 
over  the  Russian  cases  of  wolf-bite.^  He  was  heavily  over- 
worked, and  was  beset  by  a  host  of  critics,  many  of  them 
downright  fools.  All  this,  coming  to  a  quick-tempered 
man,  already  burdened  with  ill-health  and  with  griefs  of 
his  own,  made  him  what  Horsley  lightly  calls  '  irritable  '  : 
and  the  visit  of  the  Committee  was  not  well-timed. 

It  is  certain  that  they  went  with  no  sort  or  kind  of  ready- 
made  belief  in  the  method.  '  I  went  over,'  said  Brunton, 
many  years  later,  '  perfectly  convinced  that  Pasteur  was 
wrong  :  but  I  came  away  perfectly  convinced  that  Pasteur 
was  right.'  Horsley  likewise  went  over  in  doubt.  No  micro- 
organism of  rabies  had  been  discovered  :  the  method  was 
in  accord  with  the  principles  of  bacteriology,  but  did  not 
follow  the  usual  procedure  of  bacteriology  :  but  he  came 
back  with  perfect  confidence  in  it.  That  Burdon  Sanderson 
went  over  in  doubt,  is  plain  from  his  letter,  a  day  or  two 
after  he  reached  Paris,  to  Sir  James  Paget : 

I  was  present  during  M.  Pasteur's  inoculations  of  about 
one  hundred  persons,  all  supposed  to  have  been  bitten  by 
rabid  dogs — one  by  a  wolf.  Each  of  these  persons  received 
half  the  contents  of  a  subcutaneous  syringe  of  sterilised 
bouillon,  in  which  the  spinal  cord  of  a  rabbit  which  had  died 
of  '  rabies  '  was  suspended.     Of  the  thousands  of  persons 

*  '  During  the  early  part  of  March,  Pasteur  received  nineteen  Russians, 
coming  from  the  province  of  Smolensk.  .  .  .  Five  of  these  unhappy 
wretches  were  in  such  a  condition,  that  they  had  to  be  carried  to  the 
H6tel  Dieu.  .  .  .  Because  of  the  gravity  of  the  wounds,  and  to  make  up 
for  the  time  lost  by  the  Russians  before  they  started,  Pasteur  decided  on 
making  two  inoculations  every  day,  one  in  the  morning  and  one  in  the 
evening.  .  .  .  Their  condition  was  the  more  alarming,  that  a  whole  fort- 
night had  elapsed  between  their  being  bitten  and  the  date  of  the  first 
inoculations.  Statistics  were  terrifying  as  to  the  results  of  wolf-bites,  the 
average  proportion  of  deaths  being  82  per  100.  General  anxiety  and 
excitement  prevailed  concerning  the  hapless  Russians,  and  the  news  of 
the  dealii  uf  three  of  them  produced  an  intense  emotion.  Pasteur  had 
unceasingly  continued  his  visits  to  the  H6tel  Dieu.  He  was  overwhelmed 
with  grief.  ...  As  he  passed  through  the  wards,  each  patient  in  his  bed 
inspired  him  with  deep  compassion.  And  that  is  why  so  many  who  only 
saw  him  pass,  heard  his  voice,  met  his  pitiful  eyes  resting  on  them,  have 
preserved  of  him  a  memory  such  as  the  poor  had  of  St.  Vincent  de  Paul.' 
(Vallery-Radot,  Vie  de  Pasteur.)  It  is  to  be  noted  that  the  three  who  died 
had  received  only  the  '  ordinary  treatment '  :  the  sixteen  who  recovered 
had  received  the  '  intensive  treatment.' 


THE  PREVENTION  OF  RABIES  71 

who  have  been  so  injected,  none  have  experienced  either  local 
or  constitutional  effects  of  any  kind.  I  asked  Pasteur  after- 
wards whether  he  could  give  us  a  few  cases  and  groups  of 
cases  to  investigate  as  regards  their  antecedents.  He  agreed, 
and  has  given  me  the  addresses  and  photographs  of  eleven 
persons  in  the  neigiibourhood  of  Paris.  .  .  . 

In  the  afternoon  I  witnessed  the  inoculation  of  rabbits, 
which  is  done  very  skilfully  by  M.  Pasteur's  laboratory 
servant.  It  never  happens  that  the  rabbits  get  meningitis. 
They  have  no  symptoms  whatever  until  the  sixth  day  or 
later,  after  which  what  P.  calls  paralysis  comes  on  and 
the  animal  dies  a  few  days  later.  Such  a  rabbit  affords  a 
material  which,  on  the  one  hand,  can  be  injected  into  a 
human  being,  if  '  prepared,'  with  impunity,  and  on  the  other 
produces  a  specific  and  infallibly  fatal  disease  in  the  rabbit, 
which  proves  itself  to  be  rabies  by  producing  rabies  in  the  dog. 

This  fact  (if  a  fact)  appears  to  me  to  be  the  nucleus  which 
includes  everything.  If  it  is  true,  there  can  be  no  reason 
for  doubting  the  evidence  supphed  by  cases.  But  in  case 
it  should  be  found  not  to  be  true,  case  evidence  would  go 
for  nothing. 

On  April  24,  Horsley  writes  to  Sir  James  Paget  from  the 
Hotel  Louvois  :  ^ 

As  Dr.  Sanderson  left  for  Blois  on  Friday  night,  it  is  just 
possible  he  has  not  written  to  you  as  he  thought  of  doing  ; 
I  will  venture,  therefore,  to  express  what  he  talked  of  saying 
to  you. 

M.  Pasteur  expressed  some  chagrin  that  neither  yourself 
nor  Sir  Joseph  Lister  had  come  to  see  him  and  his  work  in 
connection  with  the  investigations  of  the  Commission.  This 
fact  would  not  have  so  much  importance,  were  it  not  that 
M.  Pasteur  is  in  a  very  irritable  state,  and  we  are  much  afraid 
that  the  request  which  we  intend  to  make  before  we  leave 
{viz.  to  be  given  a  rabid  spinal  cord,  and  an  inoculated  rabbit) 

*  Mr.  J.  A.  Fuller-Mai tland  writes  :  '  I  only  met  him  once,  but  it  was 
in  rather  favourable  circumstances,  at  a  small  bourgeois  hotel  in  Paris, 
the  '  Lxjuvois,'  which  has  now  blossomed  out  into  a  jiretentious  and  rather 
tiresome  place  ;  where  were  also  the  Bunion  Sandersons,  who  being  con- 
nections of  mine,  introduced  me  to  Horsley.  He  was  fearfully  excited 
about  a  discovery  of  a  whole  slice  or  section  of  a  Roman  amphitheatre  in 
the  middle  of  a  triangular  block  of  houses  out  of  tiie  Rue  Monge.  Th« 
inhabitants  had  comj)lacentIy  looked  out  of  their  back  windows  uixjn 
this  archaeological  treasure,  and  said  "  nothing  to  nobody  "  for  years. 
Then  came  a  tramway  company,  and  wanted  to  use  the  space  inside  tho 
triangle  for  their  cars,  when,  lo,  they  found  this  slice,  all  complete,  from 
the  numbered  scats  at  the  top,  to  the  wolves,  "  Christian,"  ami  other  Iwxcs 
at  the  bottom  I  At  least  that  is  my  impression,  but  I  don't  thiuk  I  ever 
got  (or  ijcrhaps  couldn't  get)  permission  to  see  it  myself.' 


72  SIR  VICTOR  HORSLEY 

will  be  refused  unless  he  cools  down  a  little.  He  was  very 
kind  on  Friday — sat  for  i^  hours  giving  me  cases  to  look 
up,  on  which  work  I  am  now  engaged,  and,  so  far,  have 
had  fair  success.  Yesterday,  for  instance,  I  investigated 
the  effects  of  nine  different  dogs.  I  may,  perhaps,  now  say 
that  Sir  Henry  Koscoe  was  of  the  opinion  that  if  you  could 
run  over  (if  only  for  a  day)  it  would  be  of  the  utmost  service  : 
and  this  was  the  point  of  Dr.  Sanderson's  letter  which  he 
proposed  to  write  to  you.  Pasteur  does  practically  nothing 
on  Sundays. 

AU  this  week  I  shall  be  engaged  in  hunting  up  cases  in  the 
immediate  neighbourhood  of  Paris,  and  then  on  Saturday  I 
shall  go  to  Lyons  and  St.  Etienne,  which  are  very  striking 
foci  of  the  disease,  and  where,  fortunately,  I  have  consider- 
able official  interest  which  will  greatly  expedite  my  re- 
searches. I  have  altogether  about  lOO  cases  to  look  up. 
M.  Pasteur  has  inoculated  about  850  individuals  representing, 
I  suppose,  about  250  dogs,  wolves,  and  a  few  cats.  The 
wolf  cases,  of  course,  are  out  of  the  question,  being  in  Russia. 
Unfortunately,  too,  the  next  largest  focus  in  France  is  the 
Basses  Pyrenees,  which  is  at  an  inconvenient  distance.  I 
have  hired  a  hght  vehicle  and  a  good  horse  for  the  day, 
i.e.  8.30-6.30,  and,  so  far,  have  found  that  very  httle  time  is 
lost. 

Will  you  kindly  tell  Miss  Paget  that  I  presented  her 
affectionate  compUments  to  Pasteur,  but  as  one  of  his 
Russian  patients  (bitten  by  a  dog)  was  dying  then,  he  was 
rather  irritable,  and  (as  possibly  my  accents,  intended  to  be 
especially  pohte,  were,  equally  certainly,  especially  British) 
he  smiled  but  httle. 

On  April  29,  he  writes  to  Mrs.  ^chafer,  thanking  her  for 
her  congratulations  on  his  nomination  for  the  Royal  Society  ; 

As  it  was  quite  understood  I  thought — from  what  my 
counsellors  told  me — that  I  had  no  chance  this  time,  it  came 
as  a  tremendous  blessing.  My  one  idea  now  is  to  hope  that 
the  Society  will  duly  elect  me  on  June  4th — a  dreadfully 
long  time  for  them  to  change  their  minds  in,  if  so  inchned. 
Let 's  hope  they  won't.  I  trust  it  wUl  hasten  matters  in  the 
hymeneal  direction,  a  road  which  is  not  very  clearly  marked 
in  my  mental  map  of  future  events.  Will  you  toll  your 
professorial  lord  that  1  shall  be  ready  to  do  any  number  of 
experiments  on  Saturday  moniing,  i.e.  the  8th,  and  possibly 
on  Friday,  but  of  that  I  will  advise  him  by  telegram.  Fact 
is,  I  run  about  from  5  a.m.  to  6  p.m.,  and  then  all  the  evening 
write  reports  of  the  notes  I  have  made  in  the  day.  I  think 
I  have  never  seen  so  much  physical  and  moral  degradation 
in  my  Ufe  as  in  the  last  ten  days.     This  place  Paris,  which  I 


THE  PREVENTION  OF  RABIES  73 

thought  I  knew  pretty  well,  is  a  perfect  sink  hterally  and 
metaphorically.^  Please  excuse  my  dilating  further,  as  I 
might,  on  what  I  have  seen  which  is  pleasing.  I  am  very 
sorry  to  ask  it,  but  I  have  so  much  to  write  I  am  afraid  of 
going  to  sleep. 

On  May  4,  he  writes  agam  to  Sir  James  Paget :  good 
news,  this  time  : 

You  will  be  glad  to  hear  that  Pasteur  (who,  two  days  ago, 
refused  Dr.  Sanderson  what  we  asked  for,  viz.  a  rabbit's 
spinal  cord)  offered  me  anything  to-day.  He  told  me  (I 
returned  from  Lyons  this  morning  early,  Dr.  Sanderson  left 
yesterday)  that  he  had  not  understood  what  Dr.  Sanderson 
wanted.  It  has  occurred  to  me  that  your  letter  to  him  may 
have  arrived  to-day,  and  that  that  was  the  cause  of  the 
fortunate  change.  However,  he  certainly  did  not  under- 
stand what  would  be  the  feeling  of  criticism  in  England  if 
we  had  simply  brought  back  two  dogs  inoculated  with  what, 
of  course,  purported  to  be  the  medulla  of  a  rabid  rabbit,  which 
was  what  was  finally  decided  upon  (as,  of  course,  much 
better  than  nothing)  by  Dr.  Sanderson.  However,  he  will 
now  give  two  rabbits,  so  that  I  can  start  the  experiments 
from  the  Rabbit,  and  that  will  be  everything. 

He  came  back  to  London  a  day  or  two  later,  and  started 
his  experiments  at  once.  Among  his  papers  are  twenty- 
six  letters  from  Pasteur,  between  May  1886  and  July  1887  : 
and  a  letter  from  Sir  James  Paget,  September  12,  1886, 
from  St.  Sauveur,  Pyrenees  : 

I  never  felt  less  hke  the  Chairman  of  a  Committee  than  I 
do  now,  writing  in  this  lovely  scenery,  with  open  window 
and  doors,  in  a  really  dehcious  cool  air ;  but  I  had  better 
pretend  to  be  in  my  place  and  say  that  I  think  you  have 
done  quite  right  with  the  bitten  man.  I  only  wish  tliat  you 
could  yourself  have  treated  him,  for  one  case  inoculated  by 
yourself  in  England  would  liave  had  great  persuasive  power 
with  some  Enghsh  people. 

And  there  arc  three  letters  from  Pasteur  to  Sir  James 
Paget,  between  May  and  August  1886.  The  first  of  them 
is  to  decline  an  invitation  to  England  :  the  other  two  arc 
to  explain  his  impatient  desire  that  the  Committee  should 
bring  out  their  Report  with  all  possible  speed  : 

'  He  was  made  sick  and  furious  by  a  man  who  offere<l  to  show  him 
'  the  night-side  of  Pans  '  :  and  at  a  theatre — some  friends  havinj;  taken  him 
to  a  play  which  offended  him— ho  walked  out  in  the  middle  of  it. 


74  SIR  VICTOR  HORSLEY 

Paris,  le  8  mai,  1886.  Cher  et  \€n€x6  maitre,  je  re9ois 
votre  aimable  lettrc  ou  vous  avez  I'obligeance  d'accumuler 
seductions  sur  seductions.  Certainement  j'ai  bien  besoin  de 
repos  et  j'aurais  un  grand  plaisir  a  allcr  pour  quelques  jours 
en  Angleterre.  Mais  pour  le  moment  c'est  impossible.  Je 
suis  pris  dans  un  engrenage  dont  je  ne  puis  sortir.  Je  songe 
cependant  sdrieusement  k  remettre  en  d'autres  mains 
I'application  de  la  mdthode  de  prophylaxie.  Mais  que  de 
peine  j'aurai  a  m'cn  d^sinteresser  ?  Kecevez,  je  vous  prie, 
I'exprcssion  de  ma  reconnaissance  et  celle  de  Mme.  Pasteur, 
et  de  mon  af lection. 

J'attcndrai  avec  une  certainc  impatience  I'effet  que  pro- 
duira  sur  le  public  anglais  le  rapport  de  la  Commission  dont 
vous  faites  partie.  Voyez,  par  I'article,  ci-joint,  extrait  du 
journal  fran^ais,  Le  Temps,  tout  ce  qui  se  passe  chez  vous 
et  chez  nous.  On  imagine  difficilement  I'hostilit^  sourde  ou 
publique  h.  laquelle  je  suis  voue  par  cette  decouverte  de  la 
prophylaxie  de  la  rage  aprcs  morsure.  Un  journal  beige, 
rempli  de  mensonges  et  de  calomnies  odieuses,  a  ^t^  jusqu'a 
insurer  dans  ses  colonnes  une  provocation  a  I'assassinat  sur 
ma  personne. 

Heureusement,  j'ai  de  quoi  m'en  consoler  de  ces  turpitudes 
en  pensant  que  je  touche  au  nombre  de  mille  personnes  d^jk 
trait^es,  et  que  je  n'ai  pas  eu  a  d^plorer  un  seul  accident  du 
au  traitement ;  que  sur  la  jeune  Pelletier  seule,  trait^e 
37  jours  apres  une  ^norme  blessure  k  la  tete  et  k  I'aisselle 
droite,  le  traitement  a  ^t^  inefficace  ;  ainsi  que  sur  quelques 
russes  mordus  par  des  loups  enrages  a  la  tete  et  au  visage. 

Prdsentez,  je  vous  prie,  mes  tres  respectueux  hommages  a 
Mme.  et  h.  Mile.  Paget,  et  recevez,  vous-meme,  I'expression 
de  tout  mon  respect. — L.  Pasteur. 

Paris,  le  12  aout,  1886.  Cher  et  illustre  maitre,  j'ai  ddja 
manifesto  au  Profr.  Horsley,  non  sans  quelque  impatience, 
le  desir  de  voir  paraitre  le  rapport  de  la  Comm""  anglaise. 
Comme  il  me  remet  de  mois  en  mois,  je  prends  la  Ubertd  de 
venir  vous  dire  le  motif  de  ma  hate  de  connaitre  le  rapport. 

Je  I'attends  impatiemment  parce  que,  dans  la  conviction 
qu'il  sera  favorable  de  tout  point  a  ma  methode  de  prophy- 
laxie, je  veux  m'aider  de  ses  termcs  et  de  ses  conclusions 
pour  faire  au  gouvemement  anglais  une  proposition  bardie. 

Je  lui  dcmanderai  I'autorisation  de  vacciner  tous  les  chiens 
lie  rile  Maurice,  \)\i\s  de  prendre  dcs  mesures  de  surveillance 
a  r(5gard  des  chiens  qui  seraient  ult^rieurement  ramen^s 
dans  I'ile. 

Je  sais  que,  sur  les  chiens,  comme  sur  les  honunes,  la  rage 
est  fr^quente  dans  cette  ile.  Ce  serait  Ik  une  grandiose 
experience  qui  serait  un  acheminement  h  la  vaccination  de 
tous  les  chiens  et  k  Textinction  de  la  rage,  qui  n'est  jamais 
spontanee. 


THE  PREVENTION  OF  RABIES  75 

Recevez,  cher  et  tr^s  dminent  maitre,  I'assurance  de  ma 
haute  consideration  et  veuille  presenter  h.  Mme.  et  a  Mile. 
Paget  rhommage  de  tout  mon  respect. — L.  Pasteur,  45  rue 
d'Ulm,  Paris. 

Arbois  (Jura)  20  aouf,  1886.  Cher  et  tres  Eminent  maitre, 
je  m'empresse  de  vous  remercier  des  excellentes  et  tres 
utiles  indications  que  vous  voulcz  bien  me  dormer  au  sujet 
de  mon  projet  de  vaccination  des  chiens  dans  une  ile  ou  la 
rage  est  frequente,  I'ile  Maurice,  de  preference.  J'attcndrai 
patiemment  le  rapport  de  la  Commission,  et  je  vais  me  mettre 
en  mesure,  comme  j'en  informe  M.  V.  Horsley,  de  lui  envoyer, 
pour  la  Commission,  la  hste  de  toutes  les  morsures  (celles  des 
loups  comprises)  qui  ont  eu  une  issue  fatale,  malgre  le 
traitement.  Je  ne  prendrai  que  tres  peu  de  jours  pour  ce 
travail.     Votre  tres  devoue  confrere,  L.  Pasteur. 

The  island  which  finally  served  to  demonstrate  the  stamp- 
ing-out of  rabies  was  not  Mauritius,  but  Great  Britain.  That 
was  the  central  fact  of  Pasteur's  teaching,  for  us  who  live 
on  an  island  :  La  rage  n'est  jamais  spontanSe  ;  rabies  cannot 
come  of  itself ;  we  over  here,  by  muzzling,  and  by  quaran- 
tine of  imported  dogs,  could  both  kill  off  rabies  and  keep  it 
from  coming  to  life  again.  There  was  no  hope  of  muzzling 
wolves  in  Russia,  or  pariah-dogs  in  India,  and  there  was  no 
hope  of  preventing  rabies  from  getting  across  the  frontier 
between  one  Continental  nation  and  another.  But  we, 
with  the  sea  for  our  frontier,  could  and  did  stamp  out  rabies 
by  Government  orders  enforced  by  the  pohce.  As  Horsley 
said,  many  years  later,  in  his  evidence  before  the  second 
Royal  Commission  on  experiments  on  animals  : 

The  freedom  of  England  from  rabies  I  take  to  be  one  of 
the  great  achievements  of  modem  science,  and  we  owe  it 
entirely  to  M.  Pa.steur.  .  .  .  Wlicn  the  Committee  was  in 
Paris,  M.  Pasteur  said  to  us,  '  Why  do  you  come  here  to 
study  my  method  ?  .  .  .  You  do  not  require  it  in  England 
at  all.  I  have  proved  that  this  is  an  infectious  disease  :  all 
you  have  to  do  is  to  establish  a  briof  quarantine  covering  the 
incubation  period,  muzzle  all  your  dogs  at  the  present 
moment,  and  in  a  few  years  you  will  be  free.'  When  the 
Committee  returned  and  reported  to  the  Houses  of  Parlia- 
ment, this  point,  of  course,  was  always  before  us. 

The  Report  of  the  Commission  of  Enquiry  was  published 
in  June  1887,  and  was  presented  by  Pasteur  on  July  4 
to  a  meeting  of  the  Academic  des  Sciences.     A  few  weekb 


76  SIR  VICTOR  HORSLEY 

before  the  Report  was  published,  he  had  written  again  to  Sir 
James  Paget : 

.  .  .  Je  n'ai  pas  besoin  de  vous  repetcr  ce  que  j'ai  dit  au 
Professeur  Horsley,  que  le  rapport  de  la  Commission  anglaise 
aura  una  importance  tres  grande,  une  importance  particuliere, 
sur  I'opinion  pubhque.  Depuis  mes  etudes  d'autrefois  sur 
la  question  des  generations,  dites  spontanees,  depuis  que  les 
'  intransigeants  '  n'osent  plus  s'elever  de  la  matiere  mindrale 
a  la  ceUule  vivante  et  de  proche  en  proche  au  singe  et  a 
I'homme,  au  nom  de  la  science,  je  suis  leur  bite  noire.  Tout 
le  parti  politique  est  irrite  contre  moi.  Joignez-y  les  anti- 
vaccinateurs,  les  anti-vivisectionnistes,  les  medecins  envieux 
et  ignorants,  et  vous  aurez  une  idee  affaiblie  des  calomnies 
qui  me  poursuivent  et  des  mensonges  que  Ton  accumule 
contre  la  m^thode  de  prophylaxie  de  la  rage. 

The  Report  of  the  Commission  says  that  Horsley's  experi- 
ments, begun  in  May  1886,  '  entirely  confirm  M.  Pasteur's 
discovery  of  a  method  by  which  animals  may  be  protected 
from  the  infection  of  rabies.  ...  It  would  be  difficult  to 
overestimate  the  importance  of  the  discovery,  whether  for 
its  practical  utility  or  for  its  appUcation  in  general  path- 
ology.' Of  the  protective  treatment  of  persons  bitten, 
the  Report  says  : 

Between  the  end  of  last  December  and  the  end  of  March, 
M.  Pasteur  inoculated  509  persons  bitten  by  animals  proved 
to  have  been  rabid  either  by  inoculation  with  their  spinal 
cords,  or  by  the  deaths  of  some  of  those  bitten  by  them,  or 
as  certified  by  veterinary  surgeons.  Only  two  have  died, 
and  one  of  these  was  bitten  by  a  wolf  a  month  before  inocula- 
tion, and  died  after  only  three  days'  treatment.  If  we  omit 
half  the  cases  as  being  too  recent,  the  other  250  have  had  a 
mortality  of  less  than  i  per  cent.,  instead  of  20  or  30  per 
cent.  .  .  .  From  the  evidence  of  all  these  facts,  we  think 
it  certain  that  the  inoculations  practised  by  M.  Pasteur  on 
persons  bitten  by  rabid  animals  have  prevented  the  occur- 
rence of  hydrophobia  in  a  large  proportion  of  those  who,  if 
they  had  not  been  so  inoculated,  would  have  died  of  that 
disease.  And  we  believe  that  the  value  of  his  discovery  will 
be  found  much  greater  than  can  be  estimated  by  its  present 
utility  ;  for  it  shows  that  it  may  become  possible  to  avert 
by  inoculation,  even  after  infection,  other  diseases  besides 
hydrophobia. 

The  Report  of  the  Committee  of  the  House  of  Lords,  which 
was  concerned  only  with  administrative  measures,  was  pub- 


THE  PREVENTION  OF  RABIES  77 

lished  a  few  weeks  later,  in  August.  This  Committee  held 
nine  sittings,  and  examined  twenty-eight  witnesses.  The 
evidence  of  Brunton,  Fleming,  Horsley,  and  Whitelegge,  is 
good  reading  now,  across  the  thirty  years  since  1887. 

In  February  1889,  at  a  meeting  of  the  Epidemiological 
Society,  Horsley  read  a  paper  on  rabies,  and  on  Pasteur's 
method.  He  spoke  of  the  occurrence  of  paralytic  rabies  in 
man  :  and  of  the  intensive  treatment.  '  It  is  evident  that 
the  intensive  treatment  is  very  successful  in  coping  with  the 
worst  cases  ;  and  that  instead  of  being  itself  a  cause  of  death, 
as  asserted  by  those  who  gain  notoriety  and  subsistence  by 
vihfying  and  misrepresenting  scientific  progress,  it  is  a  power- 
ful agent  in  saving  life.'  He  went  into  two  cases,  sent  from 
our  country  to  Paris,  in  which  the  treatment  had  failed. 
These  two  cases  had  been  much  talked  of,  and  much  that  was 
false  had  been  said  about  them.^  A  full  account  of  Pasteur's 
work  was  also  given  by  (Sir)  Armand  Ruffer  at  the  annual 
meeting  of  the  British  Medical  Association  in  Leeds. 

On  July  1, 1889,  a  meeting  was  held  at  the  Mansion  House, 
the  Lord  Mayor,  Sir  James  Whitehead,  presiding.  Horsley 
moved  one  of  the  resolutions — that  the  Government  should 
be  invited  to  introduce  a  Bill  for  the  simultaneous  muzzling 
of  all  dogs  throughout  the  British  Islands,  and  for  the  estab- 
lishment of  quarantine,  for  a  reasonable  period,  of  all  dogs 
imported.  At  this  meeting  a  fund  was  started  for  a  donation 
to  the  Pasteur  Institute,  which  had  just  been  inaugurated, 
and  for  the  help  of  necessitous  patients  who  could  not  other- 
wise afford  to  stay  in  Paris  for  the  treatment.  In  November 
1889,  the  sum  of  40,000  francs  was  sent  to  the  Institute. 

Our  country  had  not  a  '  service  de  la  rage,'  a  centre  of 
its  own  for  the  protective  treatment  against  rabies.  Our 
cases  went  to  Paris.  For  the  employment  of  Pasteur's  test, 
we  had  Horsley.  There  was  Pasteur  in  the  rue  d'Ulm,  and 
later  in  the  rue  Dutot  ;  and  there  was  Horsley  in  the  Wands- 
worth Road  :  and  that,  for  the  practical  purposes  of  any- 
body in  this  country  who  had  been  bitten  by  a  dog  either 

*  See  also  the  paper  by  Horsley  and  Bristowc,  read  at  a  meeting  of  the 
Clinical  Society,  November  9,  1888,  '  A  case  of  paralytic  rabies  in  man  ' 
(Clin.  Soc.  Trans.,  xxii.  38). 


78  SIR  VICTOR  HORSLEY 

mad  or  supposed  to  be  mad,  was  all  that  there  was.  Horsley 
had  the  two  rabbits  from  the  rue  d'Ulm.  By  transmission 
of  rabies  from  them,  he  was  able  to  demonstrate  and  uphold 
Pasteur's  method  over  here,  and  to  employ  Pasteur's  test : 
and  at  every  step  of  his  work  he  could  say  of  his  dogs  and 
rabbits  what  Villemin,  in  1865,  said  of  the  rabbits  on  which 
he  demonstrated  the  infectivity  of  tubercle,  '  En  voici  les 
preuves.' 

horsley's  wokk  on  rabies  at  the  brown 
institution 

It  was  in  May  1886,  that  he  began  the  experimental  study 
of  the  disease  :  but  his  practical  acquaintance  with  it  began 
with  his  appointment  to  the  Institution,  and  his  reports  of 
the  work  of  the  Institution,  from  1884  to  1890,  all  of  them 
call  attention  to  it.  The  writing  of  these  reports  seems  to 
have  troubled  him  :  '  The  Moloch  of  the  Annual  Report,'  he 
calls  it,  '  which  rests  on  my  shoulders  hke  the  Old  Man  of 
the  Sea  ' — a  fine  confusion  of  images.  The  statistics  of  the 
hospital  department  were  provided  for  him  by  Mr.  Ernest 
Batt,  the  veterinary  surgeon  to  the  Institution.  The  reports 
are  concerned,  of  course,  with  the  whole  output  of  each  year's 
work,  both  in  science  and  in  veterinary  practice  :  rabies  only 
comes  in  as  one  of  many  subjects. 

In  1884,  near  the  end  of  the  year,  there  was  a  slight  out- 
break of  rabies  in  London.  Of  nineteen  rabid  animals 
brought  to  the  Institution  during  the  year,  nearly  all  came 
during  the  few  weeks  of  the  outbreak,  and  many  other 
animals  in  the  neighbourhood  were  known  to  have  been 
bitten. 

In  1885,  the  number  of  rabid  animals  was  seventeen  : 

Although  rabies  has  not  been  quite  so  prevalent  in  this 
district,  it  has  raged  in  other  parts  of  London,  particularly 
in  the  N.W.  ;  and  it  is  a  matter  for  congratulation  that  the 
attention  which  was  first  drawn  by  the  Brown  Institution 
to  the  disease  has  had  the  effect  of  causing  the  authorities 
to  attempt  to  stamp  out  the  disease.  Since  the  enforced 
seclusion  of  dogs,  there  has  been  but  one  case  at  the  Brown 
Institution,  and  from  other  districts  a  sensible  diminution 
is  reported. 


THE  PREVENTION  OF  RABIES  79 

In  1886,  there  was  a  notable  decrease  of  rabies  and  there- 
fore of  hydrophobia.  Only  five  rabid  animals  were  brought 
to  the  Institution,  and  there  were  only  nine  deaths  from 
hydrophobia  in  London,  against  twenty-six  in  1885.  More- 
over, the  muzzling  order  of  November  1885  had  reduced 
not  only  rabies  but  also  distemper  : 

The  statistics  of  the  Institution  show  an  unforeseen  proof 
of  the  value  of  the  police  regulations,  especially  with  regard 
to  the  immediate  destruction  of  o\vnerless  dogs.  Distemper, 
the  most  contagious  disease  among  the  camivora,  and  not 
only  very  frequently  a  fatal  malady,  but  also  one  which  pro- 
duces the  most  lamentable  sequelae,  e.g.  blindness,  chorea, 
etc.,  has  diminished  by  more  than  one-third  of  what  it  was 
in  1885. 

During  1886-87,  at  the  Institution,  Mr.  G.  F.  Doweswell 
tested  the  action  of  many  drugs  on  rabies  :  he  found  that  it 
was  neither  prevented,  nor  influenced — unless  it  were  for 
the  worse — by  any  of  them.  In  1886,  he  beheved  that  he 
had  discovered  the  germs  of  the  disease  :  and  Horsley  for 
a  time  was  inclined  to  share  this  behcf . 

In  1887,  there  was  only  one  case  of  rabies.  But  the 
disease  was  beginning  to  work  its  way  from  Surrey  into 
South  London  :  and,  while  rabies  was  slowly  reasserting 
itself,  distemper,  having  only  a  short  period  of  incubation, 
was  rapidly  reasserting  itself.  This  year,  Horsley  established 
the  use  of  Pasteur's  test — the  subdural  inoculation  of  a 
rabbit  with  spinal-cord  tissue  from  a  case  of  rabies.  Before 
1887,  it  could  always  be  said,  '  Are  you  sure  that  the  animal 
was  really  rabid  ?  Are  you  sure  that  the  man  really  died 
of  hydrophobia  ?  '  To  these  questions,  Horsley,  and  he 
alone  in  our  country,  gave  the  fmal  answer.  If  a  minute 
portion  of  spinal  cord,  taken  from  the  dog's  body,  or  from 
the  body  of  the  man,  were  put  under  the  dura  mater  covering 
the  brain  of  a  rabbit  ;  and  if  the  rabbit,  after  the  predicted 
number  of  days,  developed  the  predicted  form  of  the  disease 
— this  evidence  was  all  that  was  needed.  In  1887,  he 
applied  this  test  to  23  specimens,  sent  to  the  Institution 
from  all  parts  of  the  country  (.|  human,  2  cows,  i  horse, 
16  dogs).  In  5  of  the  dog  cases,  the  result  was  negative  ; 
in  the  other  18  cases,  it  was  positive. 


8o  SIR  VICTOR  HORSLEY 

In  1888,  there  were  4  cases  of  rabies  brought  to  the 
Institution,  and  13  specimens  were  tested  (2  human,  i  deer, 

1  heifer,  9  dogs).  In  the  heifer  case,  and  in  5  of  the  dog 
cases,  the  result  was  negative  ;  in  the  other  7  cases,  it  was 
positive.  Horsley's  report  for  1888  was  not  in  print  till 
May  1889  :  by  which  time,  rabies  and  distemper  were  both 
of  them  on  the  increase  : 

Already  the  deaths  among  human  beings  are  rising  in 
London,  three  having  occurred  during  December  1888- 
February  1889.  Urgent  representations  should  be  made  to 
the  Privy  Council  to  ensure  adoption  of  universal  restrictive 
measures,  which,  as  has  been  proved  ad  nauseam,  are  per- 
fectly adequate  to  stamp  out  the  disease. 

In  1889,  cases  of  rabies  4  :  specimens  tested  20  (i  human, 

2  deer,  17  dogs).  In  8  of  the  dog  cases,  the  result  was 
negative  ;  in  the  other  12  cases,  positive.  The  general 
outlook  was  brighter.  Horsley's  report  for  1889,  printed 
in  July  1890,  says  : 

The  Board  of  Agriculture,  which  replaced  the  Veterinary 
Committee  of  the  Privy  Council  at  the  beginning  of  1888, 
applied  in  July  (1889)  the  muzzling  regulations  to  all  centres 
of  the  disease,  and  to  the  surrounding  districts.  The  result 
has  been  most  favourable,  not  a  single  death  among  human 
beings  having  been  recorded  in  London  since  January  i  of 
the  present  year  (1890). 

The  muzzling  regulations  had  also  brought  do\\Ti  dis- 
temper : 

The  mode  of  infection  in  distemper  is  by  contact,  the  nasal 
discharge  containing  the  virus.  The  muzzling  regulations 
of  1889  have  already  effected  a  most  marked  diminution  in 
the  number  of  dogs  and  cats  admitted  suffering  from  this 
disastrous  disease.  It  is  to  be  hoped  that  the  beneficent 
action  of  the  muzzle  will  be  allowed  to  continue,  and  that 
the  absurd  and  cruel  fallacy  that  a  dog  must  have  the  dis- 
temper will  die  out  with  the  disease. 

In  1890,  no  case  of  rabies  was  brought  to  the  Institution  : 
14  specimens  were  tested  (2  human,  i  sheep,  11  dogs).  In 
the  sheep  case,  and  in  4  of  the  dog  cases,  the  result  was 
negative  ;  in  the  other  9  cases,  it  was  positive. 

As  regards  rabies,  our  returns  show  that  not  a  single  case 
of  that  disease  was  admitted  during  1890,  while  distemper 


THE  PREVENTION  OF  RABIES  8l 

has  very  greatly  fallen,  and  indeed  the  present  moderate 
amount  of  disease  is  maintained  by  its  being  prevalent  among 
cats,  the  amount  of  cases  among  dogs  being  very  notably 
diminished. 

Fortunately  the  pubHc  has  learnt  so  much  from  its  experi- 
ence of  the  beneficent  action  of  the  regulations  since  1885, 
that  the  discreditable  anti-vivisectionist  agitation  against 
the  muzzle  will  not  mislead  in  future  those  who  are  ignorant 
of  the  manner  in  which  these  specific  diseases  are  communi- 
cated from  animal  to  animaJ. 

THE   OUTBREAK   OF   RABIES   AMONG   THE   DEER   IN 
RICHMOND   PARK,    1886-87 

Up  to  the  time  of  this  amazing  outbreak,  rabies  had  never 
been  identified  among  deer,  either  in  this  country  or  in 
France  or  in  Germany  :  but  there  had  been  outbreaks 
among  deer,  in  this  country,  of  a  disease  which,  after  1886-87, 
was  judged  to  have  been  rabies. 

The  Richmond  Park  disaster  occurred  toward  the  close 
of  a  serious  outbreak  of  rabies  among  dogs  in  London  and 
the  suburbs.  An  admirable  account  of  it  is  given  by  Mr. 
Cope.^  The  number  of  deer  in  the  Park  was  about  1200, 
in  herds  of  from  100  to  200  :  the  herds  mostly  kept  away 
from  each  other  :  they  rarely  intermixed.  The  Park  is 
open  all  day  :  it  would  be  easy  for  a  dog  to  get  in  and  bite 
one  or  more  deer  and  get  out  again.  The  outbreak  began 
in  September  1886  :  the  keepers  found  a  doe,  which  was 
suckling  a  fawn,  '  staggering  about  in  the  herd  pasturing 
near  the  entrance  gate  at  East  Sheen.'  Mr.  Cope's  report 
goes  on  to  say  : 

Some  days  after  the  death  of  this  doe,  the  keepers  noticed 
otiiers  of  the  deer  in  the  same  herd  beiiaving  in  a  very  erratic 
manner.  At  first  tliey  were  constantly  rubbmg  their  heads 
against  the  stems  of  trees  or  on  posts,  and  with  such  force 
that  their  hair  was  in  some  cases  entirely  removed.  They 
were  frequently  seen  to  be  biting  the  skin  about  tlieir  shoulders 
and  bellies  until  they  were  perfectly  raw,  tearing  out  their 
hair,  and  at  times  they  charged  at  the  other  deer.  .  .  .  The 

•  Reports  on  the  Outbreak  of  Rabies  among  Deer  in  Rjchmoml  Vask 
during  the  years  1880-7.  ^Y  ^^^-  A.  C.  Cope,  Chief  Inspector,  Agricultural 
Department,  Privy  Council  Ollice,  ami  I'rofcssor  Victor  llorslcy,  F.K.S., 
Professor  Superintendent  of  the  13rown  Institution.  London,  Eyre  and 
Spottiswoode,  1888.     Pp.  16. 

F 


82  SIR  VICTOR  HORSLEV 

disease  spread  slowly  through  the  herd,  the  animals  dying  at 
the  rate  of  four  a  week  ;  and  by  April  1887,  160  had  died. 

It  was  not  till  April  1887  that  Mr.  Cope  was  asked  to 
investigate  the  disease  : 

It  being  impossible  to  devote  sufficient  time  in  the  Park 
to  study  the  symptoms  and  nature  of  the  disease,  a  buck  and 
a  fawn  were  forwarded  to  the  Royal  Veterinary  College  ;  the 
fawn,  however,  died  four  hours  after  admission.  .  .  .  The 
medulla  of  this  animal  was  taken  to  the  Brown  Institution, 
where  under  the  direction  of  Professor  Horsley  rabbits  were 
inoculated,  which  died  of  rabies.  The  buck  became  so  wild 
and  violent  that  the  persons  in  charge  were  unable  to  enter 
the  loose  box  in  which  it  was  placed.  This  animal  died  two 
days  after  its  arrival,  and  other  rabbits  were  inoculated  with 
portions  of  its  spinal  cord,  with  the  same  results  as  in  the 
former  case. 

At  Mr.  Cope's  request,  a  dog  was  inoculated.  The  rabbits 
had  died  of  paralytic  rabies,  the  usual  fonn  of  the  disease 
in  rabbits.  The  dog  died  of  violent  rabies,  the  usual  form 
of  the  disease  in  dogs. 

In  June  1887,  the  disease  appeared  in  another  herd,  which 
had  been  grazing  in  the  Park  next  to  the  herd  first  infected. 
Altogether,  no  less  than  264  deer  died  of  rabies.  Horsley 
had  three  under  observation  at  the  Brown  Institution  :  one 
of  them,  before  admission,  had  been  seen  to  bite  another  of 
them  about  the  neck  and  ears. 

These  264  cases  of  rabies  in  deer,  and  Horsley's  authori- 
tative work  during  the  outbreak,  have  long  been  forgotten  : 
indeed,  the  whole  picture  of  rabies  in  herds  of  deer  close  to 
London  must  look  strange  to  modem  Londoners. 

THE  '  BOUISSON  BATH  TREATMENT  ' 

In  1888,  he  examined  and  exposed  the  '  Bouisson  Bath 
Treatment  for  the  Prevention  and  Cure  of  Hydrophobia.' 
It  was  the  invention  of  a  French  doctor  who  had  persuaded 
himself  that  he  was  suffering  from  hydrophobia — there  are 
many  such  cases  on  record — and  had  sought  to  kill  himself  in 
a  vapour-bath,  and  had  found  that  he  was  '  cured.'  Horsley 
published  his  results  in  the  British  Medical  Journal,  June 


THE  PREVENTION  OF  RABIES  83 

9,  1888.     He  was  bound  to  take  the  matter  seriously  :   for 
the  Bouisson  Bath  was  advertised  far  and  wide  ^ : 

As  might  be  supposed,  its  adoption  is  principally  urged  by 
those  who  are,  for  obvious  reasons,  opposed  to  the  advance- 
ment of  science,  the  paid  antivivisectionist  agitators.  These 
persons  spread  broadcast  glowing  misrepresentations  of  the 
system,  and  raise,  as  I  have  myself  seen,  many  false  hopes, 
and  so  cause  much  pain  in  the  minds  of  the  patient  and  his 
friends.  .  .  .  What  the  '  antivivisectionists  '  clearly  desire 
is  that  the  profession  at  large  should  make  a  series  of  experi- 
ments on  man  to  see  whether  tliis  Bouisson  treatment  is 
worth  going  on  with  or  not. 

He  therefore  studied  the  influence  of  vapour-baths  on 
animals  inoculated  with  rabies  :  in  some  of  them  the 
disease  was  still  latent,  in  others  it  had  already  declared 
itself :  he  could  thus  judge  whether  the  treatment  had  any 
effect  either  to  prevent  or  to  cure  the  disease  : 

I  was  careful  to  carry  out  this  treatment,  not  only  thera- 
peuticaUy,  but  also  prophylactically,  but  I  regret  to  say  that 
it  favoured  rather  than  hindered  the  course  of  the  disease, 
death  being  invariably  the  result  in  each  case. 

The  experimental  method  adopted  was  as  follows.  I 
inoculated  by  the  usual  subdural  method  eleven  animals 
with  what  M.  Pasteur  calls  the  virus  fixe — that  is  to  say, 
the  pure  virus  of  the  disease,  which,  in  the  series  that  I 
possessed,  produced  its  first  symptoms  almost  invariably 
upon  the  eighth  day  after  inoculation  ;  sometimes,  but  more 
rarely,  on  the  ninth  day.  I  also  inoculated  three  rabbits 
with  virus  taken  from  the  medulla  of  rabid  dogs  of  the  street, 
such  virus  usually  producing,  as  is  well  known,  its  first 
symptom  about  the  sixteenth  day,  but  in  certain  rarer  in- 
stances, in  the  manner  of  the  virus  fixe,  from  about  the 
seventh  to  the  nintii  day.  These  fourteen  animals  I  placed 
in  a  hot-air  bath,  according  to  Dr.  iiouisson's  suggestion, 
directly  they  sliowcd  the  hrst  distinct  symptoms  of  the 
disease. 

Finally,  I  inoculated  two  other  animals  with  the  virus  fixe, 

*  A  Bouisson  batli  was  installed  at  tho  '  Anti-vivisccUou  ll(jspital.' 
The  editor  of  one  of  tho  anti-vivisecUon  journals  published  a  statement, 
'  Tho  treatment  is  simplicity  itself  :  it  is  merely  tho  use  of  tho  vajwiir- 
bath,  which  causes  a  free  action  of  the  skin  to  bo  set  up  ;  this  draws  tho 
blood  to  the  surface  of  the  Ixjdy,  and  so  rehcvcs  tlio  congestion  of  tho 
internal  organs.'  And  the  chairman  of  one  of  the  anti-vivisecUon  soaetios 
published  a  statement  that  tho  treatment  was  '  founded  on  the  common- 
sense  principle  that  if  poison  is  injcctcrl  into  a  porson'a  veins  the  best 
thing  13  to  got  It  out  as  quickly  as  possible' 


84  SIR  VICTOR  HORSLEY 

and  on  the  third  day  after  inoculation  commenced  prophy- 
lactic treatment  with  the  hot-air  bath.  This  treatment 
antedated  by  two  days  the  onset  of  the  symptoms,  and  so 
expedited  the  fatal  results. 

Except  that  the  treatment  slightly  raised  the  temperature 
and  quickened  the  respiration,  its  only  effect  was  to  exhaust 
the  nerve-centres.  It  thus  had  a  slight  sedative  influence  : 
but  it  tended  to  hasten  death.  He  found  records  of  two 
cases  in  which  it  had  been  tried  on  man  :  in  one,  the  patient 
was  quieted  for  an  hour  or  so  :  in  the  other,  the  patient 
complained  of  the  heat  of  the  bath,  and  would  not  let  it  be 
repeated  :  both  patients  died. 

THE   SOCIETY   FOR   THE   PREVENTION   OF   HYDROPHOBIA 

The  anti-vivisectionists  also  upheld  the  false  belief  that 
rabies  could  '  come  of  itself.'  For  instance,  one  of  the  anti- 
vivisection  witnesses  before  the  Committee  of  the  House  of 
Lords  said  that  hydrophobia  was  '  a  condition  arising  in  the 
course  of  various  diseases  '  ;  and  that  if  he  broke  his  leg, 
he  might  get  hydrophobia  from  that  injury.  This  belief 
commended  itself  to  the  opponents  of  the  muzzling  of  dogs  : 
and  they  and  the  anti-vivisectionists  were  represented  by 
the  Dog  Owners'  Protection  Association.  Against  this 
Association,  in  the  autumn  of  1886,  the  Society  for  the 
Prevention  of  Hydrophobia  and  Reform  of  the  Dog  Laws 
was  formed  :  and  Horsley  became  Chairman  of  its  Com- 
mittee in  January  1887.  On  the  Committee  were  Fleming, 
Everett  Millais,  Penberthy,  Briton  Riviere,  Romaines,  and 
Tyndall.  The  Hon.  Secretary  was  Mr.  Karslake  :  Horsley 's 
many  letters  to  him,  from  1886  to  1891,  are  full  of  angry 
contempt  for  his  adversaries — as  he  profanely  says  of  the 

death  of  one  of  them,  '  What  a  divine  blessing  that has 

been  taken  away.'  Horsley  had  seen  more  cases  of  rabies 
and  hydrophobia  than  all  the  members  of  the  Dog  Owners' 
Protection  Association  together  had  seen. 

1886.  Dec.  22.  I  could  not  go  to  the  meeting  of  our 
opponents  to-night,  but  it  will  be  a  loss  if  we  cannot  get  an 
amendment  moved  to  whatever  absurd  resolution  they  pass. 
This  rcsciiidin^i  of  the  Muzzling  Order  is  most  unfortunate 


THE  PREVENTION  OF  RABIES  85 

and  ill-advised.  Dec.  27.  Thanks  very  much  for  the  Press 
notices  and  report  of  the  Enemy's  Council.  It  struck  me 
as  being  very  feeble  from  the  reports  even.  If  I  have  long 
enough  notice  to  prevent  other  engagements  I  shall  be  very 
happy  to  go  with  you  another  time  to  have  a  shy  at  them.  .  .  . 
By  the  way,  I  lecture  on  Jan.  31  at  Kensn.  Town  Hall  on 
Hydrophobia,  on  behalf  of  the  Church  of  England  Waifs 
and  Strays  Society.  You  had  better  let  me  have  a  few 
prospectuses  to  distribute  on  the  chairs  galore.  The  Dog 
Owners'  Protection  Association  will  hear  a  few  plain  truths 
if  they  come,  and  I  hope  they  will. 

1887.  Dec.  13.  The  Dog  Owners'  report  is  lovely  to  read. 

I  suppose  that  Uttle  idiot  found  himself  getting  into 

queerer  water  than  even  he  liked.  That  awful  lie  about 
Nottingham  could  best  be  met  by  sending  to  all  their  sub- 
scribers, say  270  in  number,  my  brother-in-law's  report  about 

Nottingham.     Aug.  29.  Let  the  Echo  go  to well,  where 

it  ought  to  go  :  papers  of  that  sort  make  no  final  impression. 
I  have  been  thinking  over  matters  relating  to  our  progress, 
and  I  think  that  we  have  advanced  most  materially.  The 
enemy  blaspheme  and  will,  in  spite  of  everything,  but  we  are 
really  advancing. 

1888.  May  8.  Since  I  wrote  to  you,  I  was  asked  by  the 
Govt,  to  sit  on  a  Comm.  of  Inquiry  into  Pleuropneumonia,  and 
not  being  able  to  refuse  find  my  time  completely  swamped 
and  I  may  say  without  a  halfpenny  of  return,  for  the  posi- 
tion is  purely  honorary.  Under  these  circumstances  I  am 
really  doing  enough  for  an  ungrateful  country,  or  to  put  it 
in  other  words  I  must  limit  my  other  opportunities  to  raking- 
up  bread  and  butter  somehow,  so  I  cannot  do  the  article. 

Lord is  a  \&vy  feeble  reed  indeed,  and  was  so  hipped 

over  the  character  of  the  antiviviscctionist  agitation  against 
our  views  (he  was  an  antiviviscctionist  some  years  ago)  that 
I  fancy  he  does  not  want  to  identify  himself  with  any  agita- 
tion.    June  6.  You  know  I  consider  that is  both  inane 

and  unreliable,  therefore  I  personally  do  not  wish  to  have 
anything  to  do  with  him.  However,  don't  misunderstand 
me.  I  shall  not  in  any  way  object  to  his  being  interviewed 
for  the  purposes  of  conversion  :  I  only  mean  that  I  cannot 
be  the  missionary.  Dec.  6.  Urgent.  Can  you  let  me  know 
by  return  the  name  and  town  of  the  Lancashire  lady  who 
last  year  was  so  courageous  in  defending  children  from  a 
rabid  retriever  and  who  got  severely  bitten  herself.  I  am 
informed  that  she  alone  went  to  Pasteur,  and  is  still  alive, 
whereas  the  children  bitten  died.  I  want  to  find  whether 
this  is  true  or  not,  and  in  a  hurry. 

i88g.  June.  Answer  the  idiot  as  follows.  The  increase 
of  rabies  is  demonstrated  by  the  police  returns  of  rabid  dogs 
killed.     It  was  shown  by  these  that  it  was  excessive  in  1885. 


86  SIR  VICTOR  HORSLEY 

The  muzzle  was  then  applied,  with  extra  care  in  the  destruc- 
tion of  stray  dogs.     seems  to  want  to  make  out  that 

this  was  done  for  the  first  time,  whereas  it  is  always  going 
on.  The  answer  to  his  absurd  statement  re  muzzling  is  that 
it  has  been  shown  both  here  and  abroad  that  the  slaughter 
of  strays  alone  is  not  enough  and  the  muzzle  is  also  necessary. 
The  reason  is  obvious.  The  stray  dogs  are  not  the  only  ones 
infected.  Those  cared  for  by  private  owners  are  also  diseased, 
as  emphasised  strongly  by  the  fact  that  of  recent  cases  of 
extensive  biting  of  human  beings  by  rabid  dogs,  the  large 
majority  were  by  dogs  of  private  owTiers :  some,  very 
well-to-do  people.  ...  As  to  this  last  para.,  the  evidence 
is  that  of  the  police  reports.  2h  years  ago  the  disease 
was  temporarily  extinguished  in  London,  no  case  being  re- 
ported by  the  police.  Since  that  time  the  disease,  as  shown 
by  the  same  returns,  steadily  increased  until  the  present 
spring,  when  it  suddenly  increased.  Rabies  presents  two 
periods  of  increase  :  in  the  spring  and  autumn.  We  have 
just  passed  the  spring  epidemic  increase,  and  from  our 
previous  experience  we  must  expect  another,  and  a  larger 

one,  in  November.  ...  No  panic  is  sought,  and  has 

no  right  to  make  such  a  suggestion.  It  is  with  the  object 
of  preventing  a  panic,  and  what  is  more  important,  prevent- 
ing an  outbreak  of  rabies,  that  we  wish  the  muzzle  on  now. 
That  will  do.  He  is  hardly  worth  answering.  November.  I 
hope  Millais  and  yourself  will  stop  to  dinner,  and  we  can 
go  down  to  this  absurd  meeting  afterwards.  I  will  move  an 
amendment  with  pleasure.  .  .  .  Did  you  ever  keep  those 
rascally  broadsheets  they  used  to  issue  denying  the  existence 
of  rabies  ?  If  so,  can  you  let  me  have  one  ?  Dec.  29.  But 
just  returned  from  Yorkshire,  (i)  Don't  think  appesJ  is 
required  now.  The  Government  are  evidently  now  on  their 
feet :  vide  total  want  of  opposition.  Magistrates  I  see  are 
now  fining  20/-  etc.     (2)  St.  James's  Gazette  better  left  alone. 

Article  is  clearly  by ,  and  he  anonymously  or  onymously 

is  not  worth  powder  and  shot.  I  am  not  lazy,  but  I  believe 
a  little  contempt  now,  i.e.  for  a  month,  is  good  medicine.  If 
they  follow  up,  why,  we  will  have  a  good  smash  at  them. 

1891.  February.  Owing  to  an  accident  to  Ajoion,  I  have 
to  give  a  Friday  Evening  lecture  at  the  Royal  Institution.  I 
intend  to  give  Hydrophobia  and  to  show  up  Miss  Cobbe  and 
her  lying  crew,  and  publish  the  lecture  in  the  XIX  Century 
if  Knowles  will  have  it.  In  any  case  the  statistics  for  it 
will  come  in  most  handy  for  our  paper  in  August  at  the 
Hygienic  Congress.  Can  you  help  me  in  this  very  sudden 
emergency  to  collect  the  figures  ?  I  can  collect  Pasteur's, 
but  I  must  have  London  cases  of  rabies  in  dogs  and  hydro- 
phobia in  man — and  England — at  once,  so  as  to  construct  a 
fine  red  diagram   for  the  lantern,  to  show  how  muzzhng 


THE  PREVENTION  OF  RABIES 


87 


knocked  the  wind  out  of  rabies  and  its  apostle  Miss  Cobbe — 
Science  versus  Ignorance.     Dec.  2.  Nothing   is  simpler  than 

the  demolition  of  that  blackguard .     In  the  first  place, 

are  his  quotations  true  ?     If  they  are,  come  here  at  5  o'clock, 
and  we  will  concoct  the  answer. 

The  defeat  of  the  meeting  of  the  Dog  Owners'  Protection 
Association,  November  25,  1889,  was  arranged  and  led  by 
Horsley.  He  issued  a  notice,  four  days  before,  asking 
medical  men  and  students  to  come  and  support  a  wrecking 
amendment  ;  it  was  moved  by  him,  seconded  by  Mr.  Sidney 
Turner,  and  carried  by  '  an  overwhelming  majority  '  ;  and 
the  meeting  came  to  an  end.  After  this  defeat,  the  anti- 
muzzling  movement  gradually  died  out.  Unhappily,  in 
1892,  the  Muzzling  Order  was  relaxed. 


DIAGRAM  SHOWING  THf-:  INFLUENCE  OF  MUZZLING 
OVER  RAUI1-:S. 

From  Roicn.-iu.     Published  by  permission  of  Messrs.  Appleton. 


The  enforcement  of  the  Muzzling  Order,  and  of  quarantine 
of  imported  dogs,  not  as  a  half-hearted  precaution  in  this 
or  that  district,  but  as  a  national  mctliod  of  stamping  out 
rabies  everywhere,  was  an  uphill  business  :  but  Mr.  Walter 
Long  held  on  with  it,  till  we  were  free,  at  last,  from  the 


88  SIR  VICTOR  HORSLEY 

disease,  and  from  the  fear  of  the  disease.*     Many  years 
later,  Mr.  Long  said  of  his  work  : 

When  we  embarked  upon  that  enterprise,  I  venture  to 
say  that  we  should  never  have  dared  to  do  it — and  I  may  say, 
further,  that  our  attempt  would  not  have  been  justified — 
had  it  not  been  for  the  knowledge  that  those  experts  who 
advised  us,  and  upon  whom  we  depended,  possessed  know- 
ledge which  not  only  proved  itself  to  be  incontrovertible, 
but  which  surmounted  every  difficulty  that  was  offered  to 
us  during  those  five  anxious  years. 

That  is  to  say,  it  was  Pasteur,  and  men  over  here  able  to 
judge  of  his  work,  who  strengthened  the  hands  of  our 
Government  to  make  an  end  of  rabies  and  hydrophobia.  In 
1918,  after  our  country  had  been  for  many  years  absolutely 
free  from  the  disease,  there  was  an  outbreak  of  rabies  in 
Plymouth  and  Devonport :  the  disease,  somehow,  had  been 
imported.  Strict  precautions  were  taken  :  persons  bitten 
received  the  protective  treatment,  and  no  case  of  hydro- 
phobia has  been  reported.  It  is  to  be  noted  that  the  number 
of  patients  treated  at  the  Pasteur  Institute  in  Paris  greatly 
increased  during  the  War.  The  utmost  vigilance  will  be 
needed  to  prevent  the  importation  of  infected  dogs  into  our 
country. 

Lady  Horsley  writes  : 

The  Dog  Owners'  Meeting  was  reall}'  a  very  amusing  one — 
the  crowded  hall,  the  rapidity  with  which  the  attacking  force 
were  turned  into  a  disconcerted  rabble  by  the  weight  of  the 
knowledge  opposed  to  them,  the  extreme  discomfiture  of 
the  Chairman,  the  hilarity  of  the  medical  students,  and  the 
cheerful  persistence  with  which  they  heckled  one  of  the 
speakers  with  '  How  about  that  broken  leg  ?  ' — and  Victor's 
face  flashing  with  the  joy  of  killing  a  he — all  make  up  a 
picture  that  I  shall  never  forget.  The  real  reason,  of  course, 
why  Victor  was  so  exceedingly  keen  about  this  question  was 
because,  having  seen  cases  of  hydrophobia  in  private  practice, 
the  sufferings  of  the  patients  filled  him  with  the  most  intense 


*  See  the  Report  of  the  Departmental  Committee  appointed  by  the 
Board  of  Agriculture  to  inquire  into  and  report  upon  the  working  of  the 
laws  relating  to  dogs.  Appointed  April  1896  :  Chairman,  Mr.  Charles 
A.  Whitmore,  M.P.  Horsley  gave  evidence  on  July  17.  The  Report 
was  published  1897. 


THE  PREVENTION  OF  RABIES  89 

pity.  I  think  I  am  right  in  saying  that  of  all  diseases  he 
thought  hydrophobia  the  most  awful.  He  was  caUed  down 
from  London  to  see  a  case  where  a  man,  rich  and  with  a 
well-fed  and  well-kept  dog,  had  been  bitten  by  it  and  had 
not  gone  to  Pasteur,  and  by  the  time  Victor  arrived  was  in 
the  final  stage  of  the  disease  :  and  he  was  absolutely  horrified 
with  his  sufferings. 

NOTE 

It  is  to  be  remembered  against  the  anti-vivisectionists, 
that  they  not  only  reviled  the  work  of  the  Pasteur  Insti- 
tute in  Paris,  but  also,  about  1894,  tried  to  prevent  the 
founding  of  the  Kasauli  Institute,  the  first  Pasteur  Insti- 
tute for  India.  See  Sir  Leonard  Rogers's  evidence  before 
the  Royal  Commission,  May  15,  1907. 

The  spread  of  rabies,  which  began  in  1918,  has  carried 
the  disease  into  many  parts  of  England.  At  the  present 
time  (April  30,  1919),  the  number  of  cases  confirmed  by 
the  Board  of  Agriculture  is  162.  Proper  '  services  de  la 
rage '  have  been  established  in  London  and  in  Plymouth. 
Happily,  no  case  of  hydrophobia  has  been  reported. 

There  is  an  admirable  account  of  the  relations  between 
the  Pasteur  Institute  and  our  country,  and  of  the  enforce- 
ment of  the  Muzzling  Order,  in  Sir  Rickman  Godlee's  Life 
of  Lord  Lister,  ch.  xxix.,  'The  Lister  Institute.' 

The  Society  for  the  Prevention  of  Hydrophobia  has 
lately  been  re-constituted,  with  Mr.  Sidney  Turner  as 
Chairman  of  Committee. 


VII 

The  Localisation  of  Function  in  the  Brain 

It  was  natural  that  Horsley  should  take  the  brain  as  his 
chief  subject  of  study.  The  choice  was  decided  for  him  ; 
it  was  more  compulsion  than  choice  ;  it  was  thrust  on  him 
at  lectures  and  in  talk  and  in  reading,  and  by  every  '  head- 
case  '  in  the  Hospital.  All  that  was  intellectual  in  him 
urged  him  to  care  more  for  the  seat  of  the  intellect  than 
for  any  other  organ  in  the  body  :  it  offered  him  problems 
and  opportunities  and  rewards  that  nothing  else  could  offer  : 
it  was  the  kingdom  intended  for  him,  and  he  for  it.  Not 
that  he  started  to  find  his  kingdom  with  any  philosophical 
or  psychological  theories  to  impede  him  on  the  journey. 
He  took  the  only  right  road  and  kept  it,  the  way  of  cHnical 
observation,  pathology,  and  experimental  physiology  ;  and 
was  in  very  good  company. 

In  Richet's  great  Dictionary  of  Physiology,  there  is  a  long 
review,  by  Soury,  of  theories  of  the  brain  :  beginning  with 
Alcmseon  of  Crotona,  who  hved,  as  John  Hunter  says  of 
Sonnertus, '  the  Lord  knows  how  long  ago.'  Horsley  would 
not  be  troubling  himself  over  the  theory  of  Descartes, 
that  the  pineal  body  is  '  the  seat  of  the  soul,'  nor  over 
Kant's  philosophical  answer  to  Descartes,  that  the  ego  is 
not  in  space,  and  therefore  is  not  to  be  localised  anywhere  : 
but  he  was  fond  of  quoting  from  Soury  the  case  of  Pausanias 
the  sophist,  one  of  Galen's  patients.^  But  what  concerns  us 
here   is  Soury 's   reminder,    that   the   philosophers,    physi- 

* '  I  am  fon<i  of  referring  to  Galen,'  he  says  in  an  address  in  1904, '  because 
it  is  perfectly  astonishing  what  an  amount  of  accurate  neurological  know- 
ledge Galen  acquired  by  his  experiments  on  the  lower  animals  and  demon- 
strated to  his  pupils  in  Rome.'  Again,  at  the  Festival  Dinner  of  the  Queen 
Square  Hospital  in  1907,  he  spoke  of  Galen  ;  and  drew  from  Mr.  Danvers 
Power  this  charming  compliment — '  If  Galen  was  physician  to  thegladiators 
in  his  day,  we  may  say  of  Sir  Victor  Horsley  in  our  day  that  he  is  gladiator 
to  the  physicians.' 
»0 


LOCALISATION  OF  FUNCTION  IN  BRAIN     91 

ologists,  psychologists,  and  even  the  phrenologists,  all  were 
up  against  problems  of  localisation  :  they  were  all  attempt- 
ing to  define  the  site  of  consciousness  : 

The  scientific  theory  of  cerebral  localisation  came  into  the 
world  late  enough  :  but  the  principle  of  the  locaUsation  of 
functions,  psychical,  intellectual,  and  moral,  is  almost  as  old 
as  human  thought. 

By  the  time  of  Galen,  131-200  a.d.,  it  was  agreed  that 
neither  the  heart,  nor  any  other  region  of  the  body  except 
the  brain  alone,  was  the  seat  of  sensation,  voluntary  move- 
ment, and  inteUigence.  *  Where  the  origin  of  the  nerves 
is,'  said  Galen,  '  there  is  the  command  of  the  soul.' 

Then  came  ages  of  thought,  but  not  of  experiment,  nor 
of  unfettered  thought.  The  world  had  to  wait  to  the  nine- 
teenth century  for  the  discovery  of  cerebral  localisation  : 
and  neither  philosophy  nor  psychology  had  anything  to  do 
with  it.  They  who  make  discoveries  in  the  kingdom  of  the 
natural  sciences  enter  it,  as  General  Allenby  entered  Jeru- 
salem, on  foot.  The  date  of  the  first  precise  and  followed- 
up  proof  of  cerebral  locahsation  is  1861.  It  was  on  April 
14,  1861,  that  Broca,  at  a  meeting  of  the  Anthropological 
Society  of  Paris,  showed  the  brain  of  a  man  who  for  twenty- 
one  years  had  suffered  loss  of  the  faculty  of  speaking.  He 
could  hear,  read,  understand,  and  make  himself  understood 
by  gestures  ;  his  tongue  and  his  larynx  were  not  at  fault  ; 
but  the  most  that  he  could  utter  was  a  meaningless  sound 
of  one  syllable,  tan,  Ian  :  and  once,  in  a  moment  of  anger, 
he  swore.  Year  after  year,  this  one  disability,  the  loss  of 
sp)eaking,  was  all  that  was  the  matter  with  him.  Later, 
there  came  signs  of  progressive  failure  of  the  brain.  The 
post-mortem  examination  showed  softening  of  the  left 
frontal  lobe  :  and  this  softening  had  begun  in  the  third 
left  frontal  convolution,  and  had  extended,  very  slowly, 
into  the  adjoining  convolutions.     Soury  puts  it  thus  : 

Broca  saw  clearly  what  Bouillaud  and  Aubertin  had  fore- 
seen, that  the  demonstrated  reality  of  this  first  localisation 
upheld  the  grncral  principle  of  the  localisation  (jf  the  func- 
tions of  the  brain  :  that  is,  of  the  brain  considered  hence- 
forth not  as  one  organ  with  one  function  all  of  one  sort, 


92  SIR  VICTOR  HORSLEY 

but  as  a  group  or  groups  of  organs,  diverse  in  nature  and 
distinct  in  position,  and  thus  answering  to  the  diversity  and 
the  independence  of  the  psychical  functions. 

This  case,  and  others  which  Broca  collected  and  put  on 
record,  mark  the  beginning  of  the  new  learning  :  but  he 
must  not  be  exalted  too  high  above  the  men  of  his  time, 
as  if  he  alone  had  thought  of  the  departmental  working 
of  the  brain. 

From  1861  to  1870,  the  new  learning  was  advanced  by 
clinical  and  pathological  study,  not  by  experimental  physi- 
ology. Then,  in  1870,  came  the  work  of  Fritsch  and  Hitzig  : 
it  had  not  a  wide  range  :  it  was  soon  surpassed  by  Ferrier's 
work  :  but  it  was  of  the  utmost  importance.  Men  had 
known,  for  ages,  that  the  surface  of  the  brain  is  insensitive  : 
that  it  does  not '  feel  pain  '  as  the  surface  of  the  body  '  feels 
pain  '  :  this  fact  was  as  old  as  Aristotle.  Age  after  age, 
the  insensitiveness  of  the  surface  of  the  brain  had  prevented 
men  from  understanding  the  character  of  the  surface  of  the 
brain.  Even  when  they  had  thorough  knowledge  of  its 
microscopic  structure,  and  of  all  that  had  been  made  out 
by  science  and  practice,  they  were  still  kept  back  by  the 
apparent  impossibility  of  putting  a  direct  question  to  it. 
and  getting  a  direct  answer  from  it.  That  is  to  say,  they 
were  waiting  for  the  discovery  that  the  surface  of  the  brain 
answers  to  the  electric  current.  Broca's  case  had  been  a 
demonstration,  given  by  Nature,  of  the  character  of  one 
small  area  :  Nature  had  asked  the  third  frontal  convolu- 
tion, '  What  are  you  for  ?  ' — and  it  had  answered  that  it 
was  for  the  faculty  of  speaking.  Fritsch  and  Hitzig  put 
the  question,  by  means  of  the  electric  current,  to  other 
areas  :  and,  from  some  of  them,  they  obtained  an  answer. 
It  took  the  form  of  movement  of  this  or  that  definite  group 
of  muscles  on  the  opposite  side  of  the  body.  (Opposite, 
because  of  the  crossing  over  of  nerve-fibres  at  the  base  of 
the  brain  :  whereby  the  left  cerebral  hemisphere  is  related 
to  the  right  side  of  the  body,  and  the  right  cerebral  hemi- 
sphere to  the  left  side  of  the  body.)  They  used  the  galvanic 
current,  of  a  minimal  strength,  just  enough  to  cause  a  move- 
ment :  and  they  were  able  to  map  out,  as  it  were  on  a  chart, 


LOCALISATION  OF  FUNCTION  IN  BRAIN    93 

certain  '  centres  '  for  movements  of  the  neck,  the  hmbs, 
and  the  face. 

They  pubHshed  this  discovery  in  April  1870.  (Ueber 
die  elektrische  Erregbarkeit  des  Grosshims.  In  Reichert's 
and  Du  Bois  Reymond's  Archiv,  1870,  p.  300.)  They  mark, 
on  their  diagram,  five  centres,  and  no  more.     By  1875,  their 


DIAGRAM  OF  THE  DOG'S  BRAIN,  SHOWING  THK  FIVK     MOTOR 
CENTRES'  LOCALISED  BY  FRITSCH  AND  HlTZKi,  1870. 

From  their  paper  in  Reichert's  Archiv. 

chart  was  already  out  of  date  :  still,  there  it  is,  the  first  of 
its  kind  that  ever  was  put  in  the  hands  of  men. 

Ferrier,  in  1873-75,  using  not  the  galvanic  but  the  faradic 
current  at  minimal  strength,  localised  many  more  centres, 
and  so  precisely  charted  them  that  Fritsch  and  Hitzig  were 
left  far  behind.  He  also  localised  some  centres  not  of  move- 
ments, but  of  certain  acts  of  perception.  Thus  our  country, 
in  this  field  of  exp)erimcntal  physiology,  was  soon  ahead  of 
Germany  :  as  it  was  shown  at  the  time  of  the  International 


94  SIR  VICTOR  HORSLEY 

Medical  Congress  in  London,  in  1881,  when  Ferrier  and  Yeo, 
at  a  crowded  meeting  of  physiologists,  confuted  Goltz. 
And  in  clinical  and  pathological  knowledge,  which  ulti- 
mately are  as  inseparable  from  experimental  physiology 
as  the  convexity  from  the  concavity  of  a  curve,  no  country 
was  ahead  of  ours,  no,  nor  equal  to  ours.  As  Horsley, 
long  afterwards,  said  of  Hughlings  Jackson ;  that  he 
was  '  the  father  of  neurology,  in  this  country,  and  every- 
where else.' 

This  account  of  the  arrival  of  the  new  learning  may  be 
useful  to  non-medical  readers ;  for  whom  alone  it  is  intended. 
After  1875,  the  output  of  work,  in  this  and  other  countries, 
became  so  great  that  no  man  can  describe  it.  The  main 
lines  of  it  are  clear  enough.  One  was  the  apphcation  of 
the  facts  of  cerebral  locahsation  to  the  study  of  injuries  and 
diseases  of  the  brain  ;  with  special  reference  to  cases  of 
'  Jacksonian  epilepsy.'  Another  was  the  advancement  of 
the  surgery  of  the  brain.  Another  was  the  incessant 
criticising  and  interpreting  and  adjusting  of  all  new  facts 
and  theories  as  they  came  to  hand.  Another  was  the 
modem  study  of  the  deeper  parts  of  the  brain,  and  of  the 
spinal  cord.  Along  these  and  other  lines,  all  of  them  cross- 
ing and  recrossing,  legions  of  men  were  at  work.  Thus, 
Horsley  and  his  contemporaries  came  into  the  very  thick 
of  it. 

In  January,  1884,  he  began  work  with  Professor  Schafer, 
who  in  1883  had  been  appointed  Professor  of  Physiology  at 
University  College  ;  who  writes  : 

I  had  planned,  amongst  other  work,  tlie  carrying  out  of 
a  series  of  researches  upon  the  brain  of  the  monkey,  with  the 
view  of  testing  and,  if  possible,  extending  the  work  of  Ferrier 
and  Yeo.  I  invited  Vicior  Horsley,  who  had  just  com- 
pleted his  surgical  training,  to  co-operate  with  me  :  rightly 
considering  tliat  his  skill  and  experience  in  the  methods 
of  antiseptic  surgery,  in  which  I  had  not  myself  been  trained, 
would  be  of  great  value  in  the  investigation.  We  began  our 
joint  work  in  January  1884,  and  it  was  continued  until 
July  1886,  a  period  of  two  and  a  half  years.  For  a  con- 
siderable portion  of  the  time,  Horsley  was  carrying  on 
similar  work  at  the  Brown  Institution,  in  conjunction  with 
Dr.  Beevor.    Their  observations,  although  in  some  measure 


LOCALISATION  OF  FUNCTION  IN  BRAIN    95 

coinciding  with  ours,  were  published  quite  independently, 
and  indeed  happened  to  appear  first  :  the  publication  of 
our  results  was  delayed  by  the  re-drawing  of  elaborate  illus- 
trations. Our  complete  results  were  pubHshed  in  the  Phil. 
Trans,  for  1887  :  but  this  paper  had  been  preceded  by  one 
or  two  preliminary  communications  elsewhere. 

In  the  Library  of  the  Royal  Society  of  Medicine,  there 
are  two  volumes,  presented  by  Horsley,  of  collected  papers 
from  the  Transactions  of  the  Royal  Society.  These  give 
us  the  work  which  he  did,  between  1884  and  1891,  with 
Schafer,  Beevor,  Semon,  Spencer,  and  Gotch  :  eight  papers, 
525  pages  in  all,  with  thirty-three  pages  of  plates.  The 
literary  style  of  the  papers  is  not  above  criticism  ;  they 
were  written  in  collaboration,  but  it  is  probable  that  Horsley 
did  most  of  the  writing  ;  and  he  had  not  the  knack  of 
putting  abstruse  arguments  in  easy  sentences.  He  could 
write  with  admirable  clearness  on  '  practical '  subjects  : 
but  when  he  is  thinking  his  way  through  a  labyrinth  of 
physiological  evidences,  his  style  suffers. 

The  eight  papers  are  as  follows  : 

1.  A  Record  of  Experiments  upon  the  Functions  of  the 
Cerebral  Cortex.  By  Victor  Horsley  and  E.  A.  Schafer. 
Read  February  17,  1887. 

2.  A  Minute  Analysis  (Experimental)  of  the  Various  Move- 
ments produced  by  stimulating  in  the  Monkey  different 
Regions  of  the  Cortical  Centre  for  the  Upper  Limb,  as  defined 
by  Professor  Ferrier.  By  Charles  E.  Beevor  and  Victor 
Horsley.     Read  June  10,  1886. 

3.  A  further  Minute  Analysis  by  Electric  Stimulation  of 
the  so-called  Motor  Region  of  the  Cortex  Cerebri  in  the 
Monkey  {Macacus  sinicus).  By  Charles  E.  Beevor  and 
Victor  Horsley.     Abstract  read,  June  ib,  1887. 

4.  An  Experimental  Investigation  into  the  Arrangement 
of  the  Excitable  Fibres  of  the  Internal  Capsule  of  the  Bonnet 
Monkey  {Macacus  sinicus).  By  Charles  E.  Beevor  and 
Victor  Horsley.     Read  December  12,  1889. 

5.  A  Record  of  the  Results  obtained  by  Electrical  Excita- 
tion of  the  so-called  Motor  Cortex  and  Internal  Capsule 
in  an  Orang-Outang  {Simia  satyr  us).  By  Charles  E.  Beevor 
and  Victor  Horsley.     Read  June  12,  1890, 

6.  An  Experimental  Investigation  of  the  Central  Motor 
Innervation  of  the  Larynx.  By  Felix  Semon  and  Victor 
Horsley.     Read  June  19,  1890. 

7.  On  the  Changes  produced  in  the  Circulation  and  Respira- 


96  SIR  VICTOR  HORSLEY 

tion  by  Increase  of  the  Intra-cranial  Pressure  or  Tension, 
By  Walter  Spencer  and  Victor  Horsley.  Read  June  19, 
1890. 

8.  The  Croonian  Lecture.  On  the  Mammalian  Nervous 
System,  its  Functions,  and  their  Locahsation  determined 
by  an  Electrical  Method.  By  Francis  Gotch  and  Victor 
Horsley.     Read  February  26,  1891. 

That  is  the  order  of  his  experimental  study  of  cerebral 
localisation,  from  1884  to  1891.  First,  the  more  general 
work  with  Schafer.  Then,  the  more  special  work  with 
Beevor  :  the  study  of  localisation  in  one  species  of  monkey  ; 
the  study  of  localisation  not  only  at  the  level  of  the  surface 
of  the  brain,  but  at  the  level  of  the  nerve-fibres  passing 
from  the  surface  of  the  brain  toward  the  spinal  cord  ;  and 
the  single  study  of  the  brain  of  one  anthropoid  ape.  Then, 
the  special  work  with  Semon  :  the  study  of  the  localisation 
of  centres  for  the  movements  of  the  larynx. 

The  work  with  Spencer,  and  the  work  for  the  Croonian 
Lecture  with  Gotch,  were  not  directly  concerned  with  the 
study  of  cerebral  localisation  :  they  are  noted  in  later 
chapters. 


THE  FUNCTIONS  OF  THE  CEREBRAL  CORTEX.   (wiTH  SCHAFER) 

The  method  in  these  experiments  was  either  stimulation 
with  the  faradic  current  at  minimal  strength,  or  ablation, 
i.e.  removal  of  the  little  area  of  '  grey  matter '  controlling 
this  or  that  group  of  muscles  : 

All  these  experiments  have  been  performed  with  the 
strictest  antiseptic  precautions  and  under  carbolic  spray, 
and  the  wound,  after  being  closely  stitched,  has  been  dressed 
with  antiseptic  gauze,  and  this  again  overlaid  and  rendered 
firmly  adlierent  to  the  scalp  by  a  layer  of  thick  collodion.  .  .  . 
All  the  operations  have  been  performed  under  anaesthetics, 
either  chloroform  or  ether  being  used,  almost  always  sup- 
plemented by  the  hypodermic  injection  of  morphia  (as  much 
as  from  one  half  to  one  grain  of  the  acetate  having  usually 
been  given).  This  has  the  great  advantage  of  causing  the 
animal  to  remain  perfectly  quiet  for  several  hours  after  the 
operation,  and  of  permitting  it,  during  the  slow  process  of 
recovery  from  the  effects  of  the  morphia,  to  become  accus- 


LOCALISATION  OF  FUNCTION  IN  BRAIN    97 

tomcd  to  the  collodion  dressing,  which  would  otherwise  be 
irksome,  and  this  would  load  to  attempts  at  removal.  The 
morphia  has  also  appeared  to  us  to  diminish  the  haemorrhage 
from  the  cut  cerebral  surface.  This  is  in  any  case  easily 
stayed  by  the  application  of  gentle  pressure. 

This  description  of  the  method  of  operating  may  stand 
for  all  Horsley's  experiments  on  the  nervous  system  :  except 
that  he  gave  up  the  use  of  the  spray. 

The  main  results  of  these  researches  with  Schafer  may 
be  stated,  in  outline,  as  follows  : 

1.  The  Prefrontal  Region. — '  The  results  of  our  experi- 
ments upon  the  anterior  part  of  the  frontal  lobes  have  been 
completely  negative  so  far  as  electrical  stimulation  or  the 
permanent  result  of  ablation  are  concerned.  In  this  we  are 
in  agreement  with  Ferrier  and  Yeo,  but  in  contradiction  of 
the  results  obtained  by  H.  Munk.'  They  altogether  reject 
Munk's  statement  that  the  prefrontal  convolutions  contain 
any  '  motor  centres  '  :  they  are  of  opinion  that  he  used  a 
current  of  such  strength  that  it  was  diffused  beyond  the 
points  at  which  it  was  applied,  and  that  he  was  not  suffi- 
ciently careful  over  the  enforcement  of  the  antiseptic  method. 
This  clearing  of  the  ground  was  a  great  service  to  physiology. 

2.  The  Motor  Region  of  the  Cortex. — Many  physiologists 
since  1870  had  been  studying  the  '  external '  convolutions, 
i.e.  those  on  the  convexity  of  the  brain,  on  the  surface  imme- 
diately under  the  skuU.  None  had  studied  with  equal 
attention  the  '  mesial '  convolutions,  i.e.  those  which  form 
the  walls  of  the  deep  narrow  cleft  between  the  two  hemi- 
spheres of  the  brain.  This  cleft,  the  longitudinal  fissure, 
runs  the  length  of  the  brain,  in  the  middle  hne  of  the  head  : 
and  the  mesial  surfaces  of  the  two  hemispheres  face  each 
other  like  very  high  houses  on  either  side  of  a  very  narrow 
street.  Thus,  the  mesial  surface  of  either  hemisphere  is 
less  easy  of  accass  than  the  external  surface,  and  was  still 
waiting  to  be  studied  by  the  experimental  method. 

By  their  experiments  on  the  external  surface,  Schafer 
and  Horslev  not  only  confirmed  Ferrier's  results,  but  added 
to  them,  filling  in  the  picture,  here  and  there,  with  a  finer 
analysis  of  this  or  that  group  of  movements  : 

Our  experiments  show  that  tiio  motor  portion  of  the 
cerebral  cortex  may  be  mapped  out  into  a  certain  number 
of  main  areas,  each  of  wiiich  is  chiefly  concerned  witli  the 

G 


98  SIR  VICTOR  HORSLEY 

movements  of  a  particular  part  or  limb,  and  in  some  of  which 
certain  centres  concerned  with  more  specialised  move- 
ments may  be  worked  out. 

They  describe  the  '  overlapping  '  of  adjacent  tracts — how 
every  centre  and  area  overlaps  to  a  greater  or  less  extent 
the  surrounding  areas.  That  is  to  say,  there  is  a  '  primary 
movement,'  of  this  or  that  muscle  or  group  of  muscles  on 
the  opposite  side  of  the  body,  which  is  represented,  above 
all  other  movements,  at  one  particular  point  of  the  cortex  : 


MOTOR  REGION  OF  CEREBRAL  CORTEX  (EXTERNAL  SURFACE). 

From  the  paper  by  Horslcy  and  Scliiifer  in  the  Philosophical  Transactions 
of  the  Royal  Society.     (Paper  read  February  17,  1887.) 


and  there  are  *  secondary  movements,'  which  likewise  are 
evoked  by  stimulation  at  this  particular  point,  but  are 
more  strongly  represented  at  some  adjacent  point.  Thus, 
the  same  movement  has  its  '  primary  representation  '  at 
that  point  where  it  is  most  strongly  represented,  and  its 
'secondary  representation '  at  one  or  more  adjacent  points. 
By  their  experiments  on  the  mesial  surface,  they  proved 
that  the  motor  region  extends  dowTi  over  the  greater  part 
of  the  mesial  surface  :  the  wliole  of  the  marginal  convolu- 
tion (gyrus  marginalis)  is  motor.     By  these  experiments, 


LOCALISATION  OF  FUNCTION  IN  BRAIN    99 

they  added,  to  our  map  of  the  external  motor  region,  a  map 
of  the  mesial  motor"  region. 


a.  MOTOR  REGION  OF  CEREBRAL  CORTEX  (MESIAL  SURFACE). 
F"roin  the  same  paper. 

3.  The  Occipital  Lobes. — '  Our  experiments  upo.i  the  occi- 
pital region,  though  few  in  number,  seem  to  Hnk  together 
the  conclusions  arrived  at  by  Munk,  and  by  Ferrier  and  Yeo, 
as  the  result  of  their  experiments.  They  indicate  that  the 
occipital  lobes  and  angular  gyri  are  concerned  with  visual 
perceptions,  in  such  a  manner  that  each  occipital  region  is 
connected  with  the  corresponding  lateral  half  of  each  retina, 
and  that  a  part  only  of  the  cortex  of  the  region  in  question  is 
able  to  take  on  in  great  measure — how  completely,  cannot 
be  determined  in  animals  —  the  functions  of  the  whole. 
This  is  in  conformity  also  with  the  results  obtained  by 
Luciani.' 

4.  The  Tcmfwro-Sphcnoidal  Lobe  and  the  Limbic  Lobe. — 
Their  experiments  on  the  tcmporo-sphcnoidal  lobe  gave  no 
positive  results  :  no  distinct  evidence  was  obtained  either 
for  or  against  Ferrier's  conclusion  that  the  superior  temporo- 
sphenoidal  gyrus  is  associated  with  auditory  consciousness. 
(The  '  limbic  lobe  '  is  Broca's  name  for  the  gyrus  fornicatus 
and  the  gyrus  hippocampi,  which  form  one  continuous 
structure  :  the  gyrus  fornicatus,  shown  in  diagram  2,  is  the 
convolution  below  the  gyrus  marginalis,  separated  from  it 
by  the  calloso-marginal  fissure.)     'I*heir  experiments  on  the 


loo  SIR  VICTOR  IIORSLEY 

limbic  lobe  led  them  to  conclude  that  this  portion  of  the 
cortex  is  largely,  if  not  exclusively,  concerned  with  the 
appreciation  of  sensations  of  pain  and  of  touch. 

In  later  years,  Horsley  doubted  the  validity  of  these 
experiments  on  th(^  limbic  lobe. 

II 

THE    CORTICAL   CENTRE,    IN    THE    MONKEY,    FOR   THE    UPPER 
LIMB.       (with   BEEVOR) 

Beevor  and  Horsley  begin  this  paper  with  a  study  of  the 
comparative  anatomy  of  the  upper-limb  area,  in  the  monkey 
and  in  man.  They  identify  a  small  fissure  in  the  monkey's 
brain,  which  Schafer  had  provisionally  called  sulcus  x, 
with  the  superior  frontal  sulcus  in  the  human  brain. 

They  planned  out  the  area  into  subdivisions  of  about 
4  mm.  square,  and  used  electrodes  2  mm.  apart.  The 
current  was  of  minimal  strength,  just  enough  to  give  a 
prickhng  sensation  on  the  tongue  : 

This  very  weak  secondary  current  was  always  employed, 
so  as  to  obviate  the  fallacy  of  diffusion.  That  this  object 
was  attained  was  obvious,  for,  if  a  certain  movement  was 
always  obtained  at  one  place,  shifting  the  position  of  the 
electrodes  for  even  one  millimetre  was  sufficient  to  produce 
a  totally  different  result. 

Working  thus  in  millimetres,  they  found  '  that  the 
ascending  parietal  convolution  has  less  claim  than  the 
ascending  frontal  to  be  considered  as  an  area  of  extensive 
representation  of  movement.' 

They  formulate  two  axioms,  based  on  these  experiments  : 

1.  Viewing  as  a  whole  the  '  motor  area  '  of  the  cerebral 
cortex  for  the  upper  limb,  as  defined  by  Professor  Ferrier, 
we  find  that  the  regions  for  the  action  of  the  larger  joints 
are  situated  at  the  upper  part  of  that  area,  close  to  the 
middle  line,  while  those  for  the  smaller  and  more  differen- 
tiated movements  lie  peripherally  at  the  lower  part  of  the 
area. 

2.  As  a  general  rule,  extension  of  all  the  joints,  particu- 
larly of  the  wrist  and  elbow,  is  the  most  characteristic  move- 
ment of  the  upper  part  of  Ferrier 's  arm  centre  ;  \\\\\\q.  flexion 
is   equally   characteristic   of   the   movements   obtained   by 


LOCALISATION  OF  FUNCTION  IN  BRAIN     loi 

stimulating  the  lower  part.  Finally,  between  these  two 
regions  there  is  a  small  portion  where  alternate  flexion  and 
extension  predominate,  a  condition  to  which  we  have  given 
the  name  of  confusion. 

This  confusion-theory  failed  to  gain  acceptance  among 
physiologists.  Doubtless,  the  condition  which  suggested  it 
to  Beevor  and  Horsley  was  brought  about  by  some  sHght 
diffusion  of  the  current :  they  did  not  completely  '  obviate 
the  fallacy  of  diffusion.' 

After  a  very  minute  analysis  of  these  movements,  they 
take  up  their  first  axiom,  in  its  relation  to  Hughlings  Jack- 
son's W'ork  ;  especially,  his  work  on  those  cases  of  epilepsy 
in  which  the  convulsive  movements  begin  always  in  one 
and  the  same  group  of  muscles,  and  spread  by  a  definite 
and  orderly  '  march  '  or  progress  to  other  groups.  Against 
his  will,  the  name  of  '  Jacksonian  epilepsy '  had  been  given 
to  these  cases.  He  resented  this  phrase  :  it  asserted  more 
than  it  could  prove :  he  preferred  the  phrase,  '  the  Jack- 
sonian attack.' 

It  seemed  to  us  highly  important  to  note  the  order  of 
movement  of  the  different  segments  of  the  limb — in  fact, 
the  '  march,'  as  it  lias  been  tenmd  by  Dr.  Huglilings  Jack- 
son, of  the  nerve  discharge — since  we  consider  that  a  com- 
plete series  of  observations  of  this  kind  would  enable  us  to 
construct  a  definite  scheme  which  would  show  at  a  glance 
where  certain  primary  movements  are  really  centralised. 
By  this  we  mean  that  we  applied  the  electrodes  to  the 
cortex  just  long  enough  to  evoke  movement  in  one  joint 
only,  and  then  noted  which  moved  first,  and  in  what  direc- 
tion. This  first  movement  we  considered  to  be  the  primary 
or  fundamental  movement  in  the  given  portion  of  cortex 
stimulated. 

They  were  able,  by  separate  study  of  each  square  on  their 
plan,  to  ascertain  which  of  the  joints  had  '  priority  of  move- 
ment '  in  each  cerebral  centre  or  group  of  r('ntrt\s.  They 
give  a  table  of  their  results,  and  comment  (<n  it  : 

As  is  shown  in  this  tabic,  the  sequence  in  the  movement 
of  the  parts  is  fundamentally  similar  to  that  which  had  been 
arrived  at  from  clinical  observation  by  Dr.  Hughlings  Jack- 
son in  cases  of  epilepsy.  .  .  .  The  first  and  most  fundamental 
fact  concerning  the  successive  invasion  of  the  various  joints 


I02  SIR  VICTOR  HORSLEY 

has  already  been  determined  by  Dr.  Hughlings  Jackson, 
viz.  that  when  a  movement  emanating  from  tlie  cortex,  e.g. 
of  the  upper  hmb,  begins  in  the  shoulder,  it  proceeds  down- 
ward involving  successively  the  elbow,  wrist,  and  fingers  ; 
and  inversely,  when  it  begins  in  the  thumb  and  fingers,  the 
'  march  '  proceeds  up  the  limb,  .  .  .  The  observation  of 
these  movements  as  produced  in  our  experiments  has  enabled 
us  to  form  certain  definite  generalisations  concerning  the 
order  of  their  march. 


Ill 

further  minute  analysis  of  the  motor  region, 
(with  beevor) 

In  this  paper  they  link  up  the  facts  of  experimental 
physiology  closer  to  the  facts  of  daily  experience  :  they  write 
with  more  assurance  of  the  identity  of  these  experimental 
movements  with  the  complex  purposeful  movements  of 
ordinary  life. 

For  perfect  accuracy  of  localisation,  this  series  of  experi- 
ments, twenty-three  in  all,  was  made  on  one  species  of 
monkeys.  In  each  case,  the  animal  was  killed  before 
recovering  from  the  anaesthetic.  The  usual  method  was 
followed  :  but  they  now  studied  results  not  only  at  the  centre 
of  each  square  on  the  plan,  but  also  at  midway  points.  The 
total  amount  of  observations  was  very  large.  For  example, 
they  distinguish  ten  forms  of  movement  of  the  head  and 
eyes,  and  define  the  number  and  the  position  of  the  centres 
of  primary  and  secondary  representation  of  each  of  them. 
They  even  speak  of  tertiary  and  quaternary  representation. 

I.  Movements  of  the  Head  and  Eyes. — They  call  attention 
to  the  great  extent  of  the  area  over  which  the  movement  of 
turning  tlic  licad  and  eyes  sideways  is  represented.  '  As  a 
primary  movement,  its  importance  entitles  it  to  first  con- 
sideration. Of  the  104  occasions  on  which  this  movement 
was  observed  to  occur,  in  100  instances  it  was  primary. 
This  is,  no  doubt,  a  demonstration  of  the  necessity  that 
this  primitive  movement  should  precede  all  others.'  That 
is  to  say,  the  turning  sideways  of  the  head  and  eyes,  being 
essential  to  the  perception  of  food,  the  avoidance  of  danger, 
and  so  forth,  is  ensured  by  a  very  wide  representation. 
Beevor  and  Horslcy  also  determined,  more  or  less  exactly, 
the  '  march  '  of  the  movements  of  the  head  and  eyes  ;  and 


LOCALISATION  OF  FUNXTION  IN  BRAIN     103 

found  that  the  movements  of  the  head  and  the  movements 
of  the  eyes  are  not  invariably  svnchronous. 

2.  Movements  of  the  Lower  Limb. — The  movements  of  the 
extreme  joints,  the  foot  and  the  hip,  have  a  more  important 
primary  representation  than  the  movements  of  the  inter- 
mediate joints,  the  knee  and  the  ankle. 

The  representation  of  the  lower-limb  movements  is  much 
less  higlily  differentiated  than  the  representation  of  the 
upper-limi)  movements.  That  is  to  say,  the  ordinary  experi- 
ence of  daily  life — that  whereas  the  upper  limb  performs 
movements  of  great  complexity  and  spcciaUty  of  purpose, 
the  lower  limb  is  engaged  in  actions  which  are  far  less 
specialised — is  re-stated  on  the  surface  of  our  brains. 

The  movements  of  the  hallux  (great  toe)  are  very  widely 
represented  over  almost  the  whole  of  the  lower-limb  area  : 
they  also  have  a  very  wide  primary  representation.  The 
maximum  representation,  i.e.  the  chief  region  of  primary 
representation,  is  round  the  upper  end  of  the  fissure  of 
Rolando. 

The  movements  of  all  toes  have  their  primary  representa- 
tion at  the  two  extremities  of  the  lower-limb  area.  From  these 
two  points,  their  representation  gradually  diminishes  in 
intensity  toward  the  focus  of  representation  for  the  hallux. 
The  movements  of  the  small  toes  apart  from  the  hallux  are 
poorly  represented.  '  It  is  evident,  from  the  general  rarity 
of  primary  movement  of  the  small  toes,  that  it  is  of  very 
inferior  importance  among  the  movements  of  the  lower 
limb.' 

The  representation  of  the  movements  of  the  ankle  is  what 
might  be  expected  from  the  relation  of  the  ankle  to  the 
rest  of  the  limb  :  it  takes  part  in  almost  all  the  movements 
of  the  limb,  but  it  takes  a  subordinate  part.  In  such  move- 
ments, for  example,  as  walking,  or  turning  round,  or  with- 
drawing the  foot,  it  helps,  but  does  not  start,  the  action. 
Its  representation  is  in  accord  with  its  importance.  It  has 
a  very  wide  representation,  but  mostly  secondary. 

The  movements  of  the  knee,  likewise,  have  that  representa- 
tion which  might  be  expected  from  what  we  know  of  our 
own  actions.  We  all  are  aware  that  the  movements  of  the 
knee  are  mostly  subordinate  to  the  movements  of  the  hip 
and  the  foot :  for  example,  we  flex  the  knee  to  reheve  the 
strain  of  flexion  of  the  hip.  Accordingly,  the  primary  repre- 
sentation of  the  movements  of  the  knee  is  '  most  insigni- 
ficant.' 

The  movements  of  the  hip  have  a  far  stronger  representa- 
tion. The  focus  of  representation  is  in  the  lower  anterior 
portion  of  the  lower-limb  area. 

3.  Movements  of  the  Upper  Limb. — As  in  the  lower  limb, 
so  in  the  upper  limb  the  movements  of  each  segment  have 


£04  SIR  VICTOR  HORSLEY 

that  quantity  and  quality  of  representation  to  which  the 
segment  is  entitled  by  its  contribution  to  the  ordinary  pur- 
poses of  daily  life.  Even  the  superiority  of  the  upper  limb, 
as  an  implement,  over  the  lower  limb,  is  written  on  the 
surface  of  the  brain  :  the  movements  of  the  index-fmger, 
and  of  the  wrist,  are  more  elaborately  represented  than  the 
movements  of  the  second  toe,  and  of  the  ankle  :  and  the 
representation  of  pronation  of  the  hand — the  turning  of 
the  palm  downward— is  especially  strong,  this  movement 
being  absolutely  essential  to  the  fine  and  accurate  use  of 
the  thumb  and  index-finger.  In  the  '  march  '  of  the  move- 
ments of  the  upper  limb,  also,  the  exceptional  value  of  the 
index-finger  shows  itself. 

4.  Miscellaneous  Facts. — Among  the  notes  under  this 
heading,  one  is  of  special  interest.  Beevor  and  Horsley  offer, 
with  some  hesitation,  a  theory  of  the  movements  involved 
in  the  taking  of  food.  The  area  for  the  turning  sideways 
of  the  head  and  eyes  is  situated  between  '  the  presumably 
higher  psychical  centres  of  the  prefrontal  region  '  and  the 
upper-Umb  area.  In  the  upper-limb  area,  the  centres  for 
advancing  and  extending  the  hand  lie  in  front  of  the  centres 
for  withdrawing  the  hand  and  bringing  the  arm  toward  the 
trunk.  This  anatomical  arrangement  of  the  brain's  surface 
would  come  into  use  over  the  act  of  taking  food  :  the  impulse 
would  travel  direct.  First,  the  psychic  sense  of  some  edible 
object  ;  then  the  directing  of  the  gaze  to  it  ;  then  the  reach- 
ing forward  of  the  hand  to  it  ;  lastly,  the  carrying  of  the 
hand  to  the  mouth.  They  admit  that  these  are  '  neces- 
sarily speculative  deductions ' :  still,  it  is  a  sound  theory : 
but  it  had  to  be  modified :  indeed,  it  was  modified  by  the 
observations  which  they  record  in  their  next  paper. 


IV 

the  arrangement  of  the  internal  capsule.     (with 

beevor) 

This  work  seems  to  have  been  even  more  elaborate  than 
the  work  already  done.  They  had  studied  the  surface  of 
the  brain  :  now,  they  studied  its  deeper  structures.  They 
set  themselves  to  investigate  the  anatomical  aiTangcment 
and  physiological  action  of  the  nerve-fibres  passing  down 
from  the  surface  of  the  brain  toward  the  cord.  They  studied 
these  fibres  along  that  stretch  of  their  course  which  is  called 
the  '  internal  capsule.'  This  name  is  meaningless  nowadays, 
when  we  only  think  of  a  capsule  as  a  sort  of  envelope  :   but 


LOCALISATION  OF  FUNCTION  IN  BRAIN     105 

it  had  a  meaning  in  the  days  when  anatomists  talked  Latin, 
Capsa  is  a  paper-basket,  such  as  the  Romans  used  for  hold- 
ing a  dozen  or  so  of  tail  rolls  of  manuscript.  Capsula  is  a 
little  paper-basket.  The  sheaves  of  millions  of  fibres  were 
likened  to  close-packed  rolls  of  parchments  standing  side 
by  side.  They  are  often  likened  to  the  sticks  of  a  fan  : 
but  we  have  to  think  not  of  one  but  of  thousands  of 
fans. 

On  these  fibres,  Bcevor  and  Horsley  made  forty-five 
experiments.  In  each  case,  the  animal  was  kiUed  before 
recovering  from  the  ana^thetic.  They  begin  their  paper 
with  a  review  of  the  work  done  by  others,  and  with  a  very 
minute  description,  thirteen  pages  long,  of  the  anatom}'  of 
this  part  of  the  brain.  Then  they  describe  their  method. 
They  worked  on  a  plan  of  sub-divisions  of  only  i  mm.  square  ; 
and  they  studied  the  fibres  not  only  at  one  level  of  their 
course,  but  at  eight  levels.  That  is  to  say,  they  studied 
not  one,  but  eight,  '  groups  '  of  fibres.  Each  group,  of 
course,  has  its  own  outline  on  transverse  section,  and  its 
own  position  in  relation  to  the  gangha  at  the  base  of  the 
brain,  just  as  each  cross-section  of  the  wood  of  a  tree  has 
its  own  veining.  But  the  outline  of  the  internal  capsule, 
as  a  whole,  is  a  narrow  tract  of  white  matter,  bounded  by 
the  basal  gangha,  and  having  two  '  limbs,'  anterior  and 
posterior,  at  an  obtuse  angle  to  each  other. 

Their  use  of  engine-ruled  paper  is  to  be  noted :  and  their 
method  of  standardising  the  eight  '  groups  '  of  the  fibres  : 

Upon  paper,  on  which  fine  lines  were  engraved  by  an 
eiif^iiic  with  mathematical  accuracy  so  as  to  cover  the  surface 
with  squares  (jf  i  mm.  side,  wc  drew  by  means  of  compasses 
the  exact  outline  of  the  basal  ganglia  as  exposed  by  the  section. 
In  this  way  wc  obtained  at  once  the  cut  surface  of  the  in- 
ternal capsule  correctly  projected  on  paper  divided  into 
squares  of  i  nun.  ;  these  s(|uaros  wo  then  nuni])cred  from 
tlu'  front  of  the  anterior  limb  of  tlu;  capsule  to  the  jxjstnior 
end  of  the  lenticular  nucleus.  iMually  we  stinuilated  each 
of  these  bundles  of  fibres  thus  obtained  of  i  square  mm. 
area,  and  recorded  the  effect  produced.  The  electrodes 
used  were  two  fine  |)latinum  jioints,  i  mm.  apart,  so  that 
the  excitation  should  be  exactly  limited  to  each  square 
excited.  .  .  .  After    the    experiment    was    comi^letcd,    the 


i()6  SIR  VICTOR  HORSLEY 

animal  was  killed  by  excess  of  chloroform,  the  hemisphere 
removed,  washed  in  salt  solution,  and  the  surface  photo- 
graphed. Upon  the  photograph  thus  obtained,  the  numbers 
representing  the  different  bundles  of  fibres  (i  mm.  square) 
were  transferred  by  compasses  from  the  plan  originally 
drawn  on  tlic  ruled  paper.  .  .  . 

In  plotting  out  the  plan  of  tlic  capsule  during  an  experi- 
ment, we  arranged  it  so  that  the  more  important  posterios 
limb  should  be  drawn  parallel  to  one  direction  of  the  rowr 
of  squares  on  the  ruled  paper  ;  consequently,  as  the  anterior 
hmb  forms  an  obtuse  angle  with  the  posterior  limb,  the 
squares  dividing  it  were  necessarily  dchelonned.  We  there- 
fore expressed  eacli  square,  or  bundle  of  fibres,  by  a  fraction, 
the  numerator  of  which  denoted  the  distance  that  it  was 
situated  from  the  anterior  end  of  the  capsule,  while  the 
denominator  gave  the  total  length  of  the  capsule  in  that 
particular  section.  In  this  wise,  one  fraction,  or  in  other 
words  the  position  of  one  bundle  of  fibres  in  one  section, 
is  strictly  comparable  with  that  in  another  section. 

In  order  to  bring  aU  the  fractions,  thus  obtained,  together, 
and  to  find  the  average  position  of  the  representation  of 
any  given  movement  in  each  group,  we  converted  all  the 
fractions  into  decimals  to  two  places.  We  took  two  places 
as  adequately  accurate,  since  any  error  beyond  would  only 
amount  to  ,  ^^  ^^  th  of  the  length  of  the  capsule  :  and  as  this 
actually  amounts,  on  the  average,  to  not  more  than  02  mm., 
it  is  a  length  far  too  small  to  be  considered  among  the  errors 
of  the  experimental  method. 

Working  thus  in  fractions  of  millimetres,  and  studying 
the  internal  capsule  at  no  less  than  eight  levels,  Beevor  and 
Horsley  were  able  to  construct  a  very  perfect  scheme  of  it. 
Their  paper  is  illustrated  with  many  photographs  and  many 
tables  of  figures,  and  with  152  diagrams.  The  general 
results  which  they  obtained — it  is  absurd,  to  give  a  '  sum- 
mary '  of  work  so  minute — were  as  follows  : 

1.  There  is  no  evidence  that  any  fibres  descending  from  the 
cortex  pass  into  the  basal  ganglia. 

2.  The  anterior  limb  of  the  internal  capsule  is  almost  all  of 
it  composed  of  fibres  coming  from  the  prefrontal  region. 
That  part  of  tiie  brain  is  not  immediately  concerned  with 
motor  impulses,  and  the  fibres  coming  from  it  have  no 
efferent  motor  function,  and  give  no  response  to  electrical 
stimulation. 

3.  That  portion  of  the  internal  capsule  which  does  respond 
to  stimulation  is  composed  of  fibres  coming  from  the  fronto- 
parietal region. 


LOCALISATION  OF  FUNCTION  IN  BRAIN     107 

4.  The  extremity  of  the  posterior  hmb  is  composed  of 
fibres  coming  from  the  temporal  and  occipital  regions : 
these  regions  are  not  immediately  concerned  with  motor 
impulses,  and  this  portion  of  tlie  capsule  gives  no  response 
to  stimulation. 

5.  The  excitable  fibres  are  arranged,  antcro-posteriorly, 
in  the  same  order  as  the  foci  of  representation  in  the  excitable 
portion  of  the  cortex. 

6.  Likewise,  the  arrangement,  in  the  internal  capsule,  of 
the  representation  of  the  movements  of  each  segment  of  a 
limb  corresponds  to  the  arrangement  in  the  cortex. 

7.  Likewise,  the  character  of  each  movement  is  represented 
in  the  internal  capsule,  as  in  the  cortex. 

This  last  conclusion  modified  the  importance  of  the  cortex 
as  a  factor  of  purposive  movements,  and  emphasised  Hugh- 
lings  Jackson's  teaching,  that  all  representation  is  re-repre- 
sentation ;  that  our  purposive  movements  are  represented 
at  many  lower  levels  of  our  central  nervous  system,  and 
that  the  cortex  is  nothing  more  than  the  highest  level.  As 
he  said,  '  I  believe  that  the  cerebrum  represents  all  parts 
of  the  body ;  and  that  the  cerebellum  also  represents  all 
parts  of  the  body.'  And  again,  '  Of  what  substance  can 
the  organ  of  mind  be  composed,  unless  of  processes  repre- 
senting movements  and  impressions  ?  And  how  can  the 
convolutions  differ  from  the  inferior  centres,  except  as 
parts  representing  more  intricate  co-ordinations  of  impres- 
sions and  movements  in  time  and  space  than  they  do  ?  ' 


THE  BRAIN  OF  AN  ORANG-OUTANG.   (WITH  BEEVOR) 

In  this  one  experiment  on  the  cortex  and  the  internal 
capsule  of  the  brain  of  a  young  orang-outang,  they  found 
that  the  orang  required  more  of  the  anaesthetic,  both  ab- 
solutely and  relatively,  thim  the  bonnet  monkeys  :  and 
that  a  rather  stronger  current  was  needed  to  evoke  any 
movement.  The  drawing  here  produced  was  made  by 
Horsley  at  the  time  of  the  experiment ;  it  shows  the 
numbering  of  the  2  mm.  squares  over  the  motor  area.  The 
paper  is  illustrated  with  thirty  i>hotographs  of  the  orang's 


io8 


SIR  VICTOR  HORSLEY 


brain  :  and  begins  with  a  review  of  the  comparative  anatomy 
of  the  cortex  in  the  bonnet  monkey,  the  orang,  and  man. 


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!:_# 

DRAWING  MADE  DURING  KXPERIMENT  ON  THE  MOTOR  REGION 
OF  THE  CEREBRAL  CORTEX  OF  AN  ORANG-OUTANG. 

From  the  paper  by  Beevor  and  Horilcy  in  the  Philosopliic.il  Transactions  of 
the  Royal  Society.     (Paper  read  June  12,  1890.) 


1 .  Movements  of  the  Lower  Pari  of  the  Face. — Beevor  and 
Ilorsley  note  the  great  mobility  of  the  Ups  ;  they  describe 
seven  distinct  movements  of  the  mouth  and  hps,  and  give 
the  representation  of  each  movement.  In  their  preceding 
paper,  they  had  discussed  bilateral  movements,  i.e.  those 
movements  which  are  brought  about,  simultaneously  and 
symmetrically,  on  both  sides  of  the  body,  by  the  action  of 
one  side  of  tlic  brain.  They  now  divide  the  movements 
of  the  mouth  and  lips  into  those  which  are  bilateral  and 
those  which  are  unilateral. 

2.  Movements  of  the  Tongue. — They  describe  five  distinct 
movements,  ranging  from  complete  protrusion  to  complete 
retraction.  The  representations  of  these  movements  were 
arranged  on  the  cortex  hi  a  line  from  above  downward. 


LOCALISATION  OF  FUNCTION  IN  BRAIN     109 

3.  Movements  of  the  Upper  Limb. — They  call  attention  to 
the  remarkable  individual  clearness,  the  high  '  integration,' 
of  the  representation  of  each  movement.  In  the  brain  of 
the  bonnet  monkey,  they  had  very  rarely  obtained  isolated 
primary  movements :  even  a  momentary  application  of 
the  electrodes  was  apt  to  evoke  secondary  movements  over 
and  above  the  primary  movement.  In  the  brain  of  the 
orang,  each  centre  was  more  able  to  keep  itself  to  itself : 
they  could  easily  obtain  isolated  primary  movements. 

4.  Movements  of  the  Lower  Limbs. — '  Probably  in  all  the 
higher  animals  the  representation  of  the  lower  limb  is  less 
integrated  than  that  of  the  upper  limb  :  but  it  was  especially 
necessary  to  see  what  was  the  condition  in  an  anthropoid  like 
the  orang,  whose  customary  vertical  posture  places  it  in 
an  intermediate  position  between  the  macaques  and  man.' 
In  accord  with  this  fact,  they  found,  in  the  orang's  brain,  a 
very  wide  and  highly  differentiated  representation  of  the 
movements  of  the  hip.  And  they  especially  note  that  in 
the  orang,  extension  of  the  hip  and  knee  was  produced  much 
more  often  than  flexion  :  whereas,  in  the  macaque,  flexion 
was  produced  much  more  often  than  extension. 

The  representations  of  the  movements  of  the  lower  hmb — 
liip,  knee,  ankle,  hallux,  and  small  toes — were  arranged,  on  the 
cortex  of  the  orang,  in  a  hne  from  below  upward  :  but  on 
the  cortex  of  the  macaque,  in  a  line  from  before  backward. 

From  these  facts,  Beevor  and  Horsley  deduce  a  very  in- 
genious theory,  which  they  '  venture  to  suggest  is  not  merely 
fanciful.'  The  habits  of  the  two  animals,  they  say,  seem  to 
agree  with  the  arrangement  of  their  lower-limb  centres. 
The  macaque  saves  itself  in  flight  by  climbing,  for  which 
purpose  the  first  movement  is,  of  necessity,  flexion  of  the 
hip  :  and,  in  the  macaque,  the  representation  of  this  move- 
ment is  situated  at  the  most  anterior  point  of  the  lower- 
limb  area,  just  where  it  ought  to  be  for  the  psychical  order 
of  events,  i.e.  first  the  directing  of  the  gaze,  then  the  initial 
movement  of  flight.  Tiie  orang,  for  the  initial  movement 
of  flight,  rises  on  its  lower  limbs,  extending  the  hip  and 
knee  :  and,  in  the  orang,  extension  of  these  joints  is  more 
strongly  represented  than  flexion. 

Finally,  Beevor  and  Ilorsky  come  back  to  the  extra- 
ordinarily high  differentiation  of  the  orang's  brain.  In  llic 
macaque,  they  say,  the  excitable  area  of  the  cortex  is  con- 
tinuous :  ill  the  orang,  it  is  traversed  by  intervening  zones 
which  are  not  excitable  : 

It  is  well  known  that  in  the  lower  orders  of  animals  the 
integration    of   representation    becomes   less   perfect    as   wc 


no  SIR  VICTOR  HORSLEY 

descend  in  the  scale — that,  in  fact,  it  is  increasingly  difficult 
U)  diffcivntiate  the  areas  for  the  limbs  ;  while,  on  the  con- 
trary, in  ascending  the  scale,  we  have  shown  in  our  previous 
communications  that  it  is  easy  to  differentiate  between  the 
areas  of  representation  of  even  the  segments  of  the  limbs  : 
and  finally,  when  we  now  arrive  at  the  orang,  the  segments 
are  not  only  differentiated  in  representation,  but  the  nature 
of  that  representation  is  that  of  single  movements. 

The  existence  of  non-excitable  lines  or  '  zones  '  is  not  now 
admitted  by  physiologists :  the  theory  of  the  excitability 
of  the  post-central  convolution,  also,  was  to  some  extent 
corrected  by  the  later  work  of  Sherrington  and  others.* 
None  the  less,  this  study  of  the  orang's  brain — the  first 
anthropoid  brain  thus  studied  either  in  this  country  or 
any  other — was  of  great  value. 


VI 

the  central  motor  innervation  of  the  larynx, 
(with  semon) 

There  are  two  sets  of  small  muscles  for  the  movements  of 
the  vocal  cords  :  those  which  bring  the  cords  together, 
and  those  which  draw  the  cords  apart.  These  two  sets  of 
muscles  are  called  the  intrinsic  muscles  of  the  larynx, 
because  they  are  part  of  its  structure  :  they  lie  just  under 
the  mucous  membrane.  The  large  outside  muscles,  the 
extrinsic  muscles,  which  draw  the  larynx  up  and  down  en 
masse,  have  nothing  to  do  with  the  movements  of  the  vocal 
cords. 

The  bringing  together  of  the  cords  is  called  adduction  : 
the  drawing  apart  of  the  cords  is  called  abduction.  To 
speak,  we  use  our  adductor  muscles  ;  to  take  a  deep  breath, 

•  In  1909,  in  his  Linacro  Lecture,  Ilorslcy  spoko  as  follows  of  this 
question  of  the  excitabihty  of  the  post-central  convolution:  'The  first 
experiment  in  an  anthropoid  wa,s  a  sohtary  observation  by  Dr.  Beevor 
and  myself.  We  only  obtained  evidence  of  excitability  of  the  post- 
central gyrus  at  two  points.  This  single  experiment,  confirmed  in  all 
other  essential  particulars,  has  been  superseded  by  the  extensive  researches 
of  Sherrington  and  Griinbaum,  wlio  were  enabled  to  make  a  great  many 
experiments  on  the  orang,  cliiinpanzcc,  and  even  the  gorilla.  They  found 
that  the  gyrus  post-centralis  in  the  anthropoid  was  inexcitable  to  a  stimulus 
which  evoked  a  response  from  tlic  gyrus  prc-ccntralis  ;  but  "  faciUtated  " 
elicitatioD  of  movemeat  from  the  gyrus  pre-ccntradis.' 


LOCALISATION  OF  FUNCTION  IN  BRAIN     iii 

we  use  oiir  abductor  muscles.  In  quiet  breathing,  the 
cords  are  held  about  halfway  between  adduction  and  full 
abduction. 

Semon,  in  1881,  in  the  Archives  of  Laryngology,  laid  down 
a  rule  so  importimt  that  we  may  call  it  Semon's  law.  In 
cases  of  organic  disease  involving  the  motor  nerves  of  the 
larynx,  the  abductor  muscles  fail  before  the  adductors  : 
in  cases  of  functional  disease,  the  adductors  fail  before  the 
abductors.  A  patient  with  organic  disease  involving  these 
nerves  has  difficulty  in  drawing  the  cords  far  apart,  while 
he  is  still  able  to  bring  them  together :  a  patient  with 
'  hysterical  aphonia  '  has  difficulty  in  bringing  them  together, 
but  none  in  drawing  them  apart.  On  this  fact,  Semon  and 
Horsley  founded  their  study  of  the  cerebral  centres  for  the 
control  of  respiration  and  phonation.  Three  initial  diffi- 
culties had  to  be  reckoned  with  : 

1.  They  found  differences, in  the  localisation  of  the  laryngeal 
centres,  between  different  species  of  animals. 

2.  They  found  differences  between  animals  of  the  same 
species  but  of  different  ages. 

3.  Most  unexpected  of  all,  they  found  that  the  anaesthetic, 
ether,  in  very  large  doses,  had  a  direct  local  influence  of  its 
own  on  the  larjmgeal  muscles.^ 

They  begin  their  paper  with  a  review  of  the  work  done 
by  others,  especially  by  Ferrier,  who  comes  first  of  all : 
it  was  he  who  discovered  the  cortical  centre  for  adduction. 
The  results  obtained  by  Semon  and  Horsley  must  be  divided 
according  to  the  level  at  which  they  were  observed,  and 
the  species  of  the  animal. 

I.  The  cortex. — In  the  monkey,  they  exactly  defined  the 
centre  for  adduction,  at  tiie  lower  end  of  the  ascending 
frontal  convolution.     Outside  this  focus,  there  was  an  area 

*  An  American  laryngologist,  Dr.  Hooper,  had  called  attention  to  this 
purely  local  action  of  cther-vuixjur.  Semon  and  Horsley  studied  it 
thoroughly,  and  read  a  \m\\>cx  on  it  at  the  Annual  MceliuK  in  iS8o  of  the 
British  Medical  Association.  Tiicy  argued,  from  this  sclecUve  action 
of  etlicr,  that  there  must  be  a  pliysical  dilferencc  between  the  two  groups 
of  muscles  :  and  tht-y  confirmed  tins  argument  by  a  vi-ry  simpli-  txperi- 
ment.  They  removed  the  larynx  from  an  animal  imnudiattly  after 
death,  and  exjxjscd  the  muscles  by  rapid  dissection,  and  found  tliat  the 
abductors  ceased  to  respond  to  the  faradic  current  stK)ner  tiian  the 
adductors  :   that  is  to  say,  the  abductors  died  before  the  adductors. 


112  SIR  VICTOR  HORSLEY 

where  adduction  was  less  strongly  represented  and  was 
associated  with  movements  of  the  ph:irynx.  The  adduc- 
tion was  always  bilateral.  They  found  no  cortical  centre 
for  abduction.  In  the  dog  (adult)  they  obtained  bilateral 
adduction,  usually  associated  with  movements  of  the  pharynx. 
They  found  no  centre  for  abtluction.  By  stimulation  of 
points  adjacent  to  the  centre  for  adduction,  they  were  able 
to  quicken  the  rate  and  increase  the  range  of  the  ordinary 
laryngeal  movements  of  respiration.  In  the  cat,  they  found 
a  remarkable  difference  from  the  dog.  Abduction  was 
well  represented.  In  the  rabbit,  they  found  no  focal  area 
either  for  adduction  or  for  abduction.  Such  movements 
as  did  occur  were  usually  adduction,  and  were  always 
associated  with  movements  of  the  pharynx. 

2.  The  Internal  Capsule. — The  arrangement  of  the  excitable 
fibres  of  the  internal  capsule,  from  before  backward,  was 
as  follows :  Acceleration  of  the  respiratory  movements : 
abduction  :  increased  range  of  the  respiratory  movements : 
adduction.  The  relative  position  of  these  four  groups  of 
fibres  was  '  constant  and  strictly  homologous  in  the  different 
species  of  animals.' 

3.  The  Medulla. — These  experiments  were  on  the  dog 
or  the  cat,  not  on  the  monkey.  They  proved  the  existence 
of  small  but  well-defined  areas,  on  the  floor  of  the  fourth 
ventricle,  for  adduction  (unilateral  or  bilateral)  and  for 
abduction  (bilateral). 

In  early  animal  life,  efficiency  of  respiration  is  more 
important  than  efficiency  of  phonation  :  that  is  to  say, 
abduction  is  more  important  than  adduction.  In  accord 
with  this  fact,  Semon  and  Horsley  fomid  that  abduction, 
in  all  young  animals,  had  a  much  stronger  cortical  repre- 
sentation than  adduction.  Thus,  the  central  motor  inner- 
vation of  the  larynx  —  as  Semon  had  suggested  at  the 
International  Medical  Congress  in  Copenhagen  in  1884 — 
is  adjusted  not  only  for  phonation  but  also  for  respiration  ; 
and  adapts  itself,  in  each  species  of  animal,  to  the  change 
from  early  life  to  adult  life. 

It  is  more  than  a  quarter  of  a  century,  since  the  last  of 
these  six  papers  was  published.  They  were  pioneer  work  ; 
they  have  been  modified  or  corrected  at  this  or  that  point, 
since  1800 :  none  the  less,  they  are  a  very  memorable 
achievement  in  research,  a  series  of  studies  such  as  few 
men  could  have  planned  and  put  through.     And  the  wonder 


LOCALISATION  OF  FUNCTION  IN  BRAIN     113 

is,  that  Horsley  yet  made  time  for  so  much  else — for  all 
his  work  on  myxoedema,  and  on  rabies,  and  in  Hospital : 
and  already,  in  1886,  at  Queen  Square,  was  beginning  to  use 
in  surgery  the  facts  and  the  methods  which  he  had  acquired 
from  experimental  physiology,  and  to  advance  the  surgical 
treatment  of  the  brain  and  the  spinal  cord. 


NOTE 

Dr.  A.  Salusbuiy  MacNalty,  who  can  speak  with  authority  of 
this  aspect  of  Horsley 's  work,  has  kindly  revised  and  corrected 
this  chapter. 


VIII 

From  1885  to  1887 

In  1884,  the  Brown  Institution  had  given  him  what  he  most 
needed  for  the  pursuit  of  experimental  physiology  and 
pathology  :  he  was  not  made  for  solitary  work,  nor  for  the 
teaching  of  elementary  facts  to  a  class  of  students  :  he  was 
at  his  best  when  he  was  working  with  men  of  his  own  age 
and  standing  in  science.  In  1885,  he  became  an  Assistant- 
Surgeon  to  University  College  Hospital.  In  1886,  he 
became  Surgeon  to  the  National  Hospital  for  the  Paradysed 
and  Epileptic,  Queen  Square  ;  and  Professor  of  Pathology 
at  University  College.  The  advantages  of  these  appoint- 
ments must  be  reckoned  not  by  addition  but  by  multipUca- 
tion  :  each  of  them  heightened  the  value  of  the  others. 

He  was  an  Assistant-Surgeon  to  University  College 
Hospital  from  1885  to  1893  :  a  '  Full  Surgeon  '  from  1893 
to  1900 :  and  a  '  Surgeon  in  charge  of  Hospital  Beds '  from 
1900  to  1906  :  he  then  retired,  and  was  made  a  Consulting 
Surgeon.  Thus,  he  was  on  the  visiting  staff  for  twenty-one 
years  :  but  it  was  only  for  the  last  six  years  that  he  had 
wards  of  his  own.  He  began  work  in  the  old  building  :  it 
stood  where  now  is  the  grand  new  building,  the  gift  of  Sir 
Blundell  Maple.  Horsley  was  on  a  staff  which  was  rightly 
called  *  brilliant  '  :  one  thought  of  University  College 
Hospital  as  one  thought  of  Balliol  among  the  Oxford 
Colleges.  But  there  are  no  great  events  in  this  part  of  his 
life's  work  :  it  might  almost  be  regarded  as  uneventful  :  he 
was  doing  what  other  men  were  doing.  Only,  it  helped  to 
make  him  what  he  was :  as  he  said  once,  half-jest,  half- 
earnest,  to  a  friend  who  apologised  for  consulting  him  over  a 
trivial  accident, '  I  take  all  human  infuTnity  for  m}'  province.' 
He  never  lost  hold,  in  special  surgery,  of  general  surgery. 

114 


FROM  1885  TO  1887  115 

With  his  appointment  to  University  College  Hospital,  and 
with  the  name  that  he  was  winning  for  himself,  it  was  time 
that  he  should  be  in  the  consultants'  quarter  of  London. 
The  plan  for  a  house  in  Grosvenor  Street  fell  through  :  and 
in  1885  he  moved  from  Gower  Street  to  80  Park  Street, 
Grosvenor  Square. 

On  May  12,  1885,  at  a  meeting  of  the  Royal  Medical  and 
Chirurgical  Society,  he  took  part  in  the  discussion  of  a  paper, 
by  Hughes  Bermett  and  Godlee,  on  a  case  of  removal  of  a 
tumour  from  the  brain.  The  date  of  this  operation,  the 
first  of  its  kind  either  in  this  country  or,  so  far  as  we  know, 
in  any  other,  is  November  25,  1884.  Horsley  spoke  of  what 
he  and  Schafer  had  learned  from  their  experiments  on 
monkeys  :  especially,  of  the  use  of  morphia  plus  the  anais- 
thetic,  the  use  of  a  dry  permanent  dressing,  and  the  disuse 
of  the  galvano-cautery. 

There  is  a  reference  to  these  experiments,  in  a  letter  to 
Schafer,  June  10  : 

Can  we  get  the  stimulation  experiments  supplemented  and 
published  as  soon  as  possiljle  ?  I  shall  be  quite  ready  to  do 
as  much  as  you  Hke  after  this  week.  What  are  your  arrange- 
ments as  to  holidays,  etc.  ?  Fact  is,  I  have  been  working 
at  the  same  tiling  in  choreic  dogs,  and  I  don't  find  mucli 
difference  so  far.  Then  also  our  localisation  of  motor  centres 
is  supported  by  clinical  evidence  much  more  strongly  than 
Ferrier's,  and  I  think  we  ought  to  publish  it,  altliougli  1 
am  extremely  sorry  the  two  plans  do  not  coincide  exactly. 

In  September,  he  published  notes  of  a  case  in  University 
College  Hospital,  of  septic  peritonitis,  with  recovery  after 
operation  :  this  was  his  first  contribution  to  the  hterature 
of  general  surgery. 

i886  {crt.  29) 

On  January  14,  the  Neurological  Society  of  London  was 
founded,  at  a  meeting  at  Dr.  de  Watteville's  house. 
Hughlings  Jackson  was  its  first  President  :  Hoi-sley  was  one 
of  the  original  members.  At  a  meeting  of  the  Society  on 
May  26,  in  the  physiological  laboratory  of  University 
College,  Schafer  and  Hoi-sley  opened  a  discussion,  '  On  the 


Ii6  SIR  VICTOR  HORSLEY 

sensory  and  niotui  lucalisalionb.'  At  a  meeting  on  December 
i6,  Bastian  read  a  paper,  '  On  the  muscular  sense,  its 
nature,  and  cortical  localisation.'  Horsley  was  one  of  the 
many  speakers  in  the  discussion.  The  paper  and  discussion, 
which  occupy,  in  published  form,  no  less  than  137  pages 
of  Brain,  April  1887,  were  concerned  with  the  question. 
What  is  the  true  nature  of  the  cortical  motor  centres  ?  ^ 
Bastian  gave  them  the  ill-sounding  name  of  kinaesthetic,  i.e. 
motor-sensory.  Horsley  did  not  admire  this  word :  he 
rightly  preferred  his  own  phrase,  '  the  so-called  motor 
centres.'  He  argued  from  the  microscopic  structure  of  the 
cortex ;  it  was  a  line  of  argument  which  in  1886  had  hardly 
been  attempted  :  he  advanced  a  theory,  that  the  larger 
nerve-cells,  the  '  fourth  layer  '  of  the  cortex,  probably  were 
motor  ;  and  the  smaller  nerve-cells,  the  more  superficial 
layers,  probably  were  sensory. 

The  paper  and  discussion  wasted  some  of  their  force  in 
talk  about  consciousness.  Horsley  was  on  his  guard  against 
all  such  talk.  '  It  is  not  for  me,'  he  said,  '  to  enter  to-night 
into  questions  of  much  deeper  import,  questions  of  philo- 
sophic thought.'  Bastian  had  said  that  consciousness  is 
'  of  the  nature  of  an  epiphenomenon.'  Horsley  would  not 
care  for  that  sort  of  saying  :  it  never  was  of  any  use  to  offer 
him  a  stone  for  bread. 

On  February  9,  1886,  he  was  appointed  Surgeon  to  the 
National  Hospital  for  the  Paralysed  and  Epileptic,  Queen 
Square.  It  is  not  the  only  Hospital  of  its  kind  in  London  : 
but  it  was  '  the  oldest,  the  largest,  the  richest,  and  the  best '  : 
it  was  known  far  and  wide  for  its  work  and  its  teaching.  But 
they  who  now  are  students,  or  are  just  starting  in  practice, 
can  hardly  realise  all  that  it  stood  for,  in  the  years  when  the 

»  There  was  general  agreement,  that  they  are  not  only  a  departure- 

{)latfonn  for  impulses  going  to  the  muscles,  but  also  an  arrival-platform 
or  impressions  coming  from  the  muscles  and  from  the  surface  of  the 
body.  The  movements  of  walking,  for  example,  are  the  ultimate  result 
of  certain  experiences  of  touch  and  position  and  weight  and  equilibrium  : 
they  are  decided  by  tho  '  feel  '  of  our  muscles  and  our  joints  ;  by  the  '  con- 
sciousness '  that  we  have  our  feet  on  the  ground  ;  and  by  previous  experi- 
ences of  these  impressions,  stored  up  in  us  ever  since  we  began  to  walk. 
The  arrival-platform  for  all  these  factors  of  walking  must  be  continuous 
with  the  departure-platform  for  the  act  of  wsilking  :  there  must  bo  one 
tarauaus,  under  one  roof. 


FROM   1885  TO  1887  117 

new  learning  was  new.  We  who  were  students  about  1880 
regarded  it  with  downright  reverence,  as  a  place  where  men 
thorough!}'  understood  the  nervous  system.  All  other 
systems,  and  their  diseases,  we  thought  that  we  ourselves 
imderstood :  if  not  we,  the  ph3'sicians  of  our  several  Hospitals 
understood  them  :  but  with  the  nervous  system  it  was  other- 
wise. The  diseases  of  that  system  were  not  calculable  and 
exphcable,  like  fevers,  and  diseases  of  children  :  nor  were 
they  a  fair  subject  for  an  examination  paper :  the  place  for 
them  was  Queen  Square. 

His  operating-theatre  was  simple  enough  :  it  was  a  room 
which  was  intended  for,  and  is  now,  the  day-room  of  Margaret 
Gibbins  ward.  The  Hospital's  first  operating-theatre,  which 
now  is  the  lecture-theatre,  was  opened  in  1891.  The 
present  operating-theatre  was  opened  in  1904. 

Before  Horsley,  the  appointment  had  been  held  by 
Mr.  William  Adams,  a  kindly,  skilful,  rather  old-fashioned 
surgeon,  one  of  the  foremost  representatives  of  orthopaedic 
surger}'.  He  did  all  that  could  be  done,  by  the  straightening 
of  bones,  the  division  of  tendons,  the  adjustment  of  supports, 
and  so  forth,  to  improve  the  usefulness  of  deformed,  con- 
tracted, or  paralysed  limbs.  Surgery,  up  to  1886,  had  been 
employed  at  the  Hospital  as  a  rather  mechanical  art.  Indeed, 
a  famous  London  surgeon,  who  had  thought  of  applying  for 
the  appointment,  had  been  dissuaded,  for  this  reason,  that 
it  was  below  his  dignity.  But  there  was  a  far  stronger 
reason.  The  Staff  intended  to  have  Horsley,  and  nobody 
else  :  it  might  even  be  said  that  they  created  the  appoint- 
ment for  him  :  Mr.  Adams  did  not  retire  till  1890.  In  1891, 
Mr.  (Sir  Charles)  Ballance  was  appointed  :  he  and  Horsley 
were  Surgeons  together :  and  in  1906,  Mr.  Donald  Armour 
and  Mr.  Percy  Sargent  were  appointed  Assistant-Surgeons. 

Fifty  years  ago,  and  less  than  fifty  years,  the  rules  for 
operating  on  the  head  were  those  which  Ambroise  Par6  had 
taught  and  followed  in  the  sixteenth  century.  The  con- 
ditions requiring  operation,  and  the  precautions  to  be 
observed,  were  well  known.  The  operation  of  trej)hining 
the  skull  could  not  improve  itself :  it  could  only  wait  for 
some  outside  discovery  to  improve  it.     Par(5  gives  thirty 


Ii8  SIR  VICTOR  HORSLEY 

folio  pages  to  the  treatment  of  wounds  of  the  head :  and 
he  writes  of  them  with  admirable  judgment.  Here,  for 
example,  from  Johnson's  translation,  is  one  of  his  many 
cases  : 

Monsieur  do  la  Bretcsche,  in  the  triumphant  entrance  of 
King  Henry  the  second  into  Paris,  was  so  hurt  with  a  stone, 
that  the  Os  Petrosum,  or  scaly  bone,  was  broken  with  the 
violence  of  the  blow,  and  the  temporal  muscle  was  vehemently 
contused,  yet  without  any  wound.  I  being  called  the  next 
day  (viewing  the  manner  of  the  hurt,  and  the  condition  of 
the  wounded  part)  thought  good  to  bring  some  Physicians 
and  Chirurgcons  with  me  to  consult  hereof.  .  .  .  When  all 
of  them  at  the  last  had  inchned  to  my  opinion,  I  presently 
divided  the  musculous  skin  which  was  over  the  upper  part 
of  the  fracture,  with  a  three-cornered  section  :  the  day 
following,  which  was  the  third  of  his  disease,  I  trepanned 
him  ;  and  after  I  had  done,  some  few  days  later,  I  took  out 
some  four  splinters  of  the  broken  bone  ;  and  I  put  in  a  plain 
leaden  pipe,  by  which  (I  wishing  the  Patient  ever  when  I 
drest  him  to  hold  dowTi  his  head,  to  stop  his  mouth  and  his 
nose,  and  then  strive  as  much  as  in  him  lay  to  put  forth  his 
breath)  much  sanious  matter  came  forth,  which  was  gathered 
between  the  skull  and  Crassa  Meninx.  Other  filth  which 
stuck  more  fast,  I  washed  out  with  a  detergent  decoction, 
injected  with  such  a  Syringe  as  is  here  exprest  ;  and  I  did 
so  much,  God  blessing  my  endeavours,  that  at  length  he 
recovered. 

The  method  of  operating  by  stages  in  such  cases  was  given 
up  :  but  that  is  not  the  point  here.  The  point  is  that  a 
surgeon,  half  a  century  ago,  could  not  do  more  than  Pax6 
had  done.  He  must  have  something  to  guide  him,  some- 
thing to  go  by  :  wound  or  scar  or  depressed  fracture. 
Trephining,  of  itself,  was  not  brain-surgery,  but  skull- 
surgery  ;  it  was  the  repairing  of  the  roof  of  the  house  of  life. 
The  skull  must  be  dealt  with,  for  the  sake  of  the  brain  :  but 
the  less  that  the  surgeon  saw  of  the  brain,  the  better  he  was 
pleased. 

The  date  of  the  earliest  recorded  case,  in  this  country,  of 
real  brain-surgery,  is  1876.  A  boy  of  eleven,  a  patient  of 
Macewen  of  Glasgow,  showed  signs  of  acute  brain-disease 
which,  from  the  evidences  of  cerebral  localisation,  '  were 
judged  to  indicate  cerebral  abscess  situated  in  the  left 
frontal  lobe,  in  the  immediate  vicinity  of  the  base  of  the 


FROM  1885  TO  1887  119 

third  frontal  convolution,  between  the  speech-centre  and 
the  internal  capsule.'  There  speaks  the  new  learning,  with 
authority  :  Nova  rerum  nascitur  ordo.  Macewen  desired 
to  operate  without  delay,  but  the  operation  was  put  off  by 
the  boy's  friends  ;  he  died  thirty  hours  after  the  consulta- 
tion ;  Macewen  was  allowed  to  perform  the  operation  post 
mortem,  and  found  the  abscess  where  he  had  locahsed  it. 
His  next  case,  an  abscess  in  the  left  temporo-sphenoidal 
lobe,  was  in  1881 :  he  operated,  and  found  the  abscess  :  but 
it  had  already  infected  the  lateral  ventricle,  making  the  case 
hopeless.  The  first  successful  operation  in  this  country 
for  temporo-sphenoidal  abscess  was  by  Arthur  Barker,  in 
1886.  We  can  count  on  our  fingers  the  cases  of  modem 
brain-surgery  recorded  in  our  surgical  literature,  up  to  the 
time  of  Horsley's  appointment  to  Queen  Square. 

He  was  more  than  qualified  for  it  ;  he  was  the  one  man 
for  it.  He  had  been  engaged  for  two  years,  in  his  work  with 
Schafer  and  with  Beevor,  over  brain-surgery  on  monkeys  ; 
he  had  done  more  than  a  hundred  of  these  operations  on 
animals  ;  he  brought  to  Queen  Square  a  precise  and  habitucd 
method  ;  he  had  worked  it  out  on  monkeys,  he  did  not 
have  to  work  it  out  on  man.  Especially,  he  had  acquired 
familiarity  with  brain-surgery  under  the  very  conditions 
which  he  would  find  at  Queen  Square  ;  the  conditions  of 
operating  with  neither  wound  nor  scar  nor  depressed 
fracture  to  guide  him,  nor  anything  else  except  the  facts  of 
cerebral  localisation.  Six  points  in  his  method  are  to  be 
noted  :  but,  of  course,  as  time  went  on,  he  modified  it  here 
and  there  : 

1.  He  was  absolutely  determined  to  prevent  wound- 
infection. 

2.  He  was  thoroughly  familiar  with  the  action  of  anaes- 
thetics on  the  brain. 

3.  Instead  of  the  old  cruciform  incision,  he  made  a  long 
curved  incision  and  turned  down  a  flap  of  skin  and  muscle, 
so  as  to  expose  the  skull  very  freely.  There  was  another 
advantage  ;  the  flap,  when  it  was  brought  back  into  posi- 
tion and  secured  with  sutures,  kept  up  steady  pressure  over 
the  brain. 

4.  He  knew  exactly  how  to  expose  the  brain  by  a  rapid 
and  well-planned  removal  of  bone.     So  early  as  1887,  he 


120  SIR  VICTOR  HORSLEY 

added,  to  the  use  of  the  trephine  and  the  bone-cutting 
forceps,  the  use  of  a  miniature  circular  saw  driven  by  a 
Bonwill's  surgical  engine. 

5.  He  never  used  the  galvano-cautery. 

6.  To  stop  bleeding  from  the  cut  edge  of  the  bone,  he 
devised  the  use  of  antiseptic  wax.^ 

The  date  of  his  first  operation  at  Queen  Square  is  May 
25,  1886.  The  patient,  a  young  Scotsman  aged  twenty-two, 
had  been  run  over  when  he  was  seven,  and  had  been  in 
the  Edinburgh  Royal  Infirmary  under  Annandale,  with  a 
compound  fracture  of  the  left  side  of  the  skull  and  escape  of 
brain-substance.  At  the  age  of  fifteen,  he  began  to  have 
fits :  he  was  in  Queen  Square  in  1885,  and  was  readmitted 
in  1886.  The  mind  was  dull,  there  was  partial  paralysis  of 
the  right  arm  and  leg,  and  the  fits  were  of  extraordinary 
frequency  :  he  had  2870  fits  during  his  first  thirteen  days  in 
Hospital.  The  '  march '  of  the  fits  was  well  defined.  The 
gap  in  the  skull  from  the  original  injury  lay  over  the  upper 
third  of  the  left  ascending  frontal  convolution.  The 
diagnosis  was  '  scar  involving  the  hinder  end  of  the  superior 
frontal  sulcus,'  Horsley  removed  the  scar  in  the  brain,  and 
the  surrounding  brain-substance,  to  a  depth  of  two  centi- 
metres. The  wound  healed  well :  the  mental  condition 
was  improved :  and  the  fits  ceased. 

The  physicians  watched  the  operation  with  keen  interest : 
and  when  it  was  over,  Hughlings  Jackson  let  himself  enjoy 
the  relaxation  of  the  strained  mind.  He  beckoned  to 
Ferrier  :  '  Awful,  perfectly  awful,'  he  said.  Ferrier  was 
shocked  :  the  operation  had  seemed  to  him  faultless.  Again 
Hughlings  Jackson  murmured  that  an  awful  mistake  had 
been  made.  '  Here  's  the  first  operation  of  this  kind  that 
we  have  ever  had  at  the  Hospital  :  the  patient  is  a  Scots- 
man. We  had  the  chance  of  getting  a  joke  into  his  head, 
and  we  failed  to  take  advantage  of  it.' 

On  May  28,  at  a  meeting  of  the  Clinical  Society,  Horsley 
read  a  paper  '  On  a  case  of  suppuration  of  the  mastoid  cells  : 
with  remarks  on  the  prevention  of  septic  embolism  in  such 

*  In  his  experiments  in  1885,  he  had  made  use  of  ordinary  modelling 
wax,  worked  soft  in  the  fingers.  See  bis  letter,  Brit.  Med.  Journ.,  1892, 
i.  1165. 


FROM  1885  TO  1887  T2I 

cases.'  This  paper  contains  the  first  suggestion  ever  made 
in  this  country,  or,  so  far  as  we  know,  in  any  other,  for  the 
ligature  of  the  jugular  vein  in  cases  where  suppuration, 
spreading  from  the  ear  to  the  mastoid  bone,  has  caused  the 
formation  of  a  clot  of  blood  (thrombosis)  in  the  lateral  sinus 
of  the  brain  ;  particles  of  the  clot  may  be  carried  by  the 
circulation  into  the  heart  and  lungs  (embolism)  :  the 
ligature  of  the  jugular  vein  would  prevent  this  : 

There  remains  the  question  how  to  prevent  embolism  of 
the  thoracic  viscera,  supposing  thrombosis  to  be  well  declared. 
The  solution  of  this  problem  is  a  simple  matter  enough, 
looking  at  it  from  the  merely  mechanical  point  of  view  ; 
resolving  itself  of  course  into  the  not  very  serious  operation 
of  ligature  of  the  jugular  vein  in  the  middle  of  the  neck.^ 

In  August,  at  the  Annual  Meeting  of  the  British  Medical 
Association  in  Brighton,  Horsley  read  a  short  paper  '  On 
Brain-Surgery.'  He  had  done  three  operations  at  Queen 
Square  :  he  described  them,  and  showed  the  patients — May 
25,  excision  of  scar  ;  June  22,  removal  of  tubercular  tumour 
and  of  the  thumb-area  ;  July  13,  removal  of  splinter  of  bone 
and  surrounding  cyst.  This  paper  was  the  great  event  of  the 
Brighton  meeting.  In  the  discussion  of  it,  Charcot,  Hugh- 
lings  Jackson,  and  Erichsen  were  among  those  w^ho  con- 
gratulated him. 2    Erichsen  said  : 

The  old  lines  of  ordinary  cUnical  observation  and  dead- 
house  pathology  have  long  since  been  followed  to  their  final 
termination  :  we  can  but  multiply  the  facts  already  so 
carefully  observed  and  so  admirably  recorded  by  countless 
observers  in  every  civihsed  country.  It  is  not  to  following 
these  old  Unes  that  modem  surgery  will  owe  its  advance  ; 
but  it  is  in  the  application  to  it  of  those  means  of  experi- 

*  In  1888,  Sir  Arbuthnot  Lane  proved  the  value  of  this  mctliod  (Clin. 
See.  Trans.,  xxii.  255)  ;  and  in  1890  Sir  Charles  Ballance  fornuilatcd 
exact  rules  for  it,  and  brought  it  into  general  recognition  :  see  his  classical 
paper,  in  the  Proceedings  of  the  Medical  Society  of  London,  March  21,  1890. 

*  He  stayed  at  Lancing,  witli  Mr.  Frank  Cutlack  ;  who  writes,  '  I  can 
recall  his  preparations  the  day  before  the  lecture,  when  he  had  his  diagrams 
and  an  array  of  instruments  all  spread  out  in  my  conservatory.  On  Iho 
afternoon  of  the  lecture,  I  ran  into  tlie  Itrigliton  I'avilion  to  pick  him  up  : 
in  time  to  sec  his  patient  walking  up  an<l  ilown  the  platform,  and  to  hear 
deligiitful  old  Cliarcot  in  his  courteous  way  thank  H(jrs!cy  for  his  lecture, 
and  for  his  wonderful  services  to  suffering  mankind.  It  was  indeed  a 
glorious  triumpli,  as  even  a  layman  such  as  I  could  perceive,  for  so  young 
a  professional  man.' 


122  SIR  VICTOR  HORSLEY 

mental  research  which  are  now  being  worked  out  in  the 
biological  and  pathological  laboratory,  that  we  may  hope 
to  find  the  solution  of  many  of  those  problems  that  have 
hitherto  baffled  the  surgeon. 

Horsley's  fourth  operation  at  Queen  Square,  September 
23,  was  wonderful  indeed.  The  patient  was  completely 
paralysed  on  the  left  side,  was  suffering  from  fits,  and  had 
been  semi-comatose  for  ten  days  before  the  operation.  The 
diagnosis  was  '  tumour  of  the  cortex  involving  the  upper 
part  of  the  arm-centre  in  the  right  hemisphere.'  Horsley 
removed  a  mass  of  glioma  of  4^  oz.  weight.  The  patient 
regained  consciousness  ;  the  fits  ceased  ;  the  mental  state 
remained  perfect  for  three  months ;  and  the  paralysis  became 
less  marked,  till  he  could  walk  with  a  little  help.  He  died 
of  recurrence  of  the  disease,  six  months  after  the  operation. 

By  the  end  of  1886,  Horsley  had  done  ten  operations  at 
Queen  Square.  Nine  had  been  successful — ranging  from 
improvement  to  complete  recovery.  One  had  been  followed 
by  death  :  the  patient  was  a  boy  with  cerebellar  tumour  : 
he  was  worn  out  with  pain,  vomiting,  and  fits ;  was  paral3'sed, 
more  or  less,  in  all  four  limbs  ;  and  had  been  bed-ridden  for 
a  year  before  the  operation. 

At  the  Brown  Institution  this  year — beside  all  his  other 
work  there — he  made  many  experiments  on  epilepsy :  his 
Brown  Lectures,  at  the  end  of  the  year,  were  two  of  them 
on  the  thyroid  gland,  and  three  on  epilepsy  (Lancet,  1886, 
ii.  1 163,  121 1).  He  spoke  of  the  confusion  of  theories  of 
epilepsy,  and  of  the  vague  phrases  in  which  the  disease  was 
described.  He  would  have  nothing  to  do  with  Nothnagel's 
theory  of  the  existence  of  '  special  convulsive  centres.'  He 
discussed  the  value  of  the  theory  that  each  hemisphere 
'  represented  both  sides  of  the  brain  ' :  and  said  that  it  could 
not  be  proved  either  from  chnical  evidence  or  from  experi- 
mental evidence.  He  emphasised  the  evidences  of  the  in- 
dependent action  of  each  hemisphere  apart  from  the  other ; 
he  was  of  opinion  that '  convulsions  due  to  cortical  discharge 
are  evoked  in  various  groups  of  muscles  by  nerve  energy 
proceeding  from  that  centre  in  each  hemisphere  which  is 
in  relation  to  each  group  of  muscles,  and  that  in  general- 


FROM  1S85  TO  1887  123 

ised  epileptic  convulsions  both  cerebral  hemispheres  are 
involved.' 

He  made  a  special  series  of  experiments  on  the  disease, 
during  March- July,  planned  on  the  Unes  of  Brown-Sequard's 
work :  with  direct  reference  to  a  very  strange  case  of 
epilepsy  which  was  under  the  care  of  Hughlings  Jackson. 
This  case  was  described  by  Hughlings  Jackson  at  a  meeting 
of  the  Medical  Society,  on  November  15  ;  and  Horsley 
showed  at  this  meeting  some  instantaneous  photographs  of 
epileptic  guinea-pigs. 

About  this  time,  also,  he  made  two  experiments  on  the 
results  of  removal  of  the  pituitary  body  :  partly,  because  of 
the  association  of  epileptiform  movements  with  disease  of 
the  pituitary  body  ;  partly,  because  of  the  analogy  between 
the  pituitary  body  and  the  thyroid  gland.* 

Other  events  of  this  memorable  year  were  as  follows : 
(i)  He  was  elected  a  Fellow  of  the  Royal  Society.  (2)  He 
published  a  translation  of  Koch's  monograph  '  On  the 
Investigation  of  Pathogenic  Micro-organisms.'  ^  (3)  He  dis- 
puted with  Schiff  (Brain,  April  and  October  1886)  over  the 
course  of  certain  tracts  of  the  spinal  cord,  and  their  con- 
nection with  the  motor  area  of  the  cortex  :  he  had  the  last 
word  in  this  elaborate  controversy  ;  and  he  fought,  it  seems, 
with  ease,  and  even  with  enjoyment. 

1887  {cBt.  30) 

On  March  4,  at  the  Royal  Institution,  and  later  at  the 
Harveian  Society  and  the  Anthropological  Institute,  he 
lectured  on  '  Brain-Surgery  in  the  Stone  Age.'  He  had 
studied  in  Paris  the  prehistoric  skulls,  with  marks  of  trephin- 

»  These  seem  to  have  been  the  first  experiments  ever  made  on  the 
pituitary  Ixnly.  The  connection  between  enlargement  of  the  pituitary 
body  and  the  disease  called  '  acromegaly  '  bad  not  then  been  tlrtamcd  of. 
It  is  true  that  Pierre  Marie's  note,  '  Sur  deux  c;is  d'acromd'galie,'  was  pub- 
hshed  in  Apnl  ib86:  but  he  made  out  nothing  at  that  time  as  to  the 
cause  of  the  disease  (Revue  de  M^decinc,  Aprd  1886).  It  was  not  tdl  1891 
that  he  and  Georges  Mannesco  pubhshcd  '  Sur  L'Anatomie  Pathologiquo 
d'Acrom6galie  '  (Archives  dc  M6dccme,  1891,  i.  3,  539.  See  also  New 
Sydenham  Society,  1891). 

»  This  translation,  seventy -eight  pages  long,  is  in  '  Recent  Essays  by 
various  authors  on  nartcria  in  relation  to  Disease':  e<lited  by  Watson 
Cheyne,  pubhshcd  by  the  New  Sydcnliam  Society,  London,  ibhO. 


124  SIR  VICTOR  IIORSLEY 

ing  on  them,  in  the  Broca  Museum  of  Anthropology,  and 
had  taken  many  photographs  of  them.  Never  were  lecturer 
and  subject  more  happily  suited  to  each  other.  All  his  life, 
he  delighted  in  the  study  of  ancient  monuments— British 
barrows,  Roman  camps,  Norman  churches,  all  the  banked-up 
and  built-up  history  of  the  countryside  ;  archaeology  not  in 
glass-cases  but  under  the  open  air  :  he  had  that  sense  of  the 
past  of  the  earth  which  is  in  Mr.  Kipling's  Puck  of  Pook's 
Hill :  he  loved  to  explore  and  to  excavate  :  and  the  notes 
and  maps  and  photographs  of  his  findings  at  Lympne  in  1893, 
and  at  Eynhallow  Monastery  in  191 1 — many  days  of  hard 
open-air  work  at  Lympne,  starting  at  6.30  a.m.,  with  men 
under  him — bear  witness  to  his  diligence.  Thus,  the  fact 
that  trephining  was  practised  far  and  wide  in  the  Stone 
Age  found  its  proper  exponent  in  him,  who  was  both  surgeon 
and  antiquarian.  The  skulls  in  Paris  had  been  waiting  for 
him  ever  since  they  were  trephined  :  and  he  set  everybody 
talking  about  them. 

It  does  not  appear  that  he  published  this  lecture ;  but  it 
was  reported  far  and  wide  :  and  there  is  a  good  abstract  of 
it,  and  of  a  discussion  after  it,  in  the  Journal  of  the  Anthro- 
pological Institute,  xvi.  100.  From  the  marks  on  the  skulls, 
Horsley  judged  that  the  trephining  had  been  done,  in  most 
cases,  by  sawing  :  which  in  some  cases  might  have  been 
supplemented  by  scraping.  In  almost  all  cases,  it  had  been 
done  over  the  motor  region  of  the  brain  :  and  he  ventured  on 
a  very  ingenious  theory  : 

This  region  of  the  brain  is  the  seat  of  origin  of  that  special 
form  of  convulsions  which  is  known  as  Jacksonian  epilepsy, 
and  which  so  frequently  follows  injuries  to  the  skull  and 
brain.  .  .  .  This  special  form  of  epilepsy  most  usually  com- 
mences with  a  peculiar  sensation  in  one  delinite  part  of 
the  body,  whence  it  travels  up  the  limb  towards  the  head — 
this  usually  constituting  the  aura  or  warning  of  the  onset 
of  tlic  fit.  This  factor  is  of  special  importance,  since  it 
commonly  happens  that  at  the  moment  when  the  sensation 
appears  to  reach  the  head,  consciousness  is  lost.  If,  more- 
over, the  mischief  is  occasioned  by  a  depressed  fracture, 
there  will  be  considerable  tenderness  at  the  injured  place  ; 
and  this  becomes  exaggerated  at  the  period  of  convulsions. 
Putting  these  facts  together,  with  minor  details  of  such 


FROM  1885  TO  1887  125 

cases,  too  numerous  to  be  mentioned  here,  the  following 
mode  in  which  tlie  practice  may  have  originated  among  so 
savage  a  people  seems  to  be  possible. 

The  tender  cicatrix  may  first  have  been  excised  as  the 
source  of  pain.  This  probably  would  have  produced  a 
temporary  benefit,  sufficient  to  encourage  the  patient  to 
undergo,  in  cases  of  relapse,  a  further  operation  for  the  re- 
moval of  bone.  This  would  in  most  cases  be  followed  by 
rehef,  not  only  of  the  pain,  but  of  the  fits  also.  Conse- 
quently the  operation  would  gain  a  certain  reputation  for 
the  cure  of  convulsions  generally,  and  as  such  might  have 
been  frequently  practised. 

In  the  discussion  at  the  Anthropological  Institute,  Francis 
Galton  said  that  this  theory  implied  more  intelligence  than 
savages  usually  showed.  '  In  their  surgery  and  medicine 
they  were  apt  to  proceed  in  a  very  offhand,  ruthless,  and 
unintelligent  manner,  following  their  fancies  and  super- 
stitions rather  than  experience.'  Miss  Buckland  and 
Professor  Leith  said  that  the  trephining  had  been  done  to  let 
out  the  evil  spirit,  and  that  convulsions  would  have  been 
regarded  as  possession  :  but  they  did  not  accept  the  argu- 
ment from  the  position  of  the  trephine-openings. 

In  April,  he  published  in  the  International  Jourucd  oi 
Medical  Sciences  his  first  contribution  to  American  literature : 
an  essay  on  the  accurate  use  of  such  lines  and  angles  of 
measurement  as  give  the  relations  between  the  surface  of 
the  skull  and  the  surface  of  the  brain,  and  enable  the  surgeon 
to  visualise  the  motor  area  of  the  brain  in  its  exact  position 
under  the  skull.  The  necessity  for  this  surveying  of  the 
skull  had  become  urgent ;  much  had  been  done  toward  it, 
but  not  enough  : 

The  necessity  has  arisen  so  rapidly  within  the  last  few 
years  as  to  force  each  practical  surgeon  to  work  out  the 
required  facts  for  himself  with  tlie  aid  of  the  few  papers 
that  have  appeared  on  the  subject.  In  the  absence  of  any 
such  desired  comprchcnsivo  monograph  giving  a  complete 
directory,  as  it  were,  of  those  parts  of  the  brain  whose  func- 
tion is  so  far  understood  as  to  permit  of  the  locaHsation 
of  lesions  within  their  boundaries,  a  pcrs(jnal  experience, 
which  has  so  far  fortunately  l)een  equal  to  tlie  exigencies 
of  ten  cases  sul>m  ittod  to  operation,  may  be  of  use  to  those 
who  are  similarly  called  upon  to  explore  the  cranial  cavity. 


126  SIR  VICTOR  HORSLEY 

On  June  6,  at  a  meeting  of  the  Odontological  Society,  he 
read  a  paper  '  On  avulsion  of  the  fifth  nerve  in  trigeminal 
neuralgia.'  This  was  the  beginning  of  his  work  and  of  his 
teaching  for  the  operative  treatment  of  the  disease.  From 
this  beginning  he  went  on  to  the  operation  for  removal  of 
the  Gasserian  ganghon.  No  surgeon  will  ever  surpass  him 
in  skill  and  in  judgment  over  this  very  difficult  operation  : 
and,  in  the  carhcr  years,  none  was  equal  to  liim. 

Three  days  later,  came  an  event  which  takes  a  great  plac^ 
in  the  history  of  surgery.  It  was  on  June  9,  1887,  that  he 
removed  a  tumour  from  the  spinal  cord  :  the  first  operation 
of  its  kind  that  ever  was  done.  The  patient  was  an  officer 
in  the  Army  :  he  had  suffered  for  three  years,  and  had  been 
subjected  to  all  sorts  of  worse  than  useless  treatment.  The 
pain  had  been  so  intense  that  the  question  had  been  raised 
whether  he  were  quite  sane.  Early  in  1887,  he  began  to 
lose  power  over  his  legs.  By  June  1887,  he  was  suffering 
not  only  horrible  pain,  '  increased  to  evident  agony  on  any 
movement,'  but  partial  paralysis  of  the  bladder  and  com- 
plete paralysis  of  the  legs.  He  was  seen  in  consultation  by 
Sir  William  Gowers,  Sir  William  Jenner,  and  Dr.  Percy 
Kidd  :  and  Horsley  was  asked  to  operate.  The  case  is 
recorded  by  Gowers  and  Horsley  (Trans.  Roy.  Med.  Chir. 
Soc,  liii.  'ijy).  After  a  description  of  the  operation,  Horsley 
considers,  one  by  one,  the  objections  which  were  in  force 
against  operating  on  cases  of  fracture  of  the  spine  with 
injury  to  the  spinal  cord.  These  were  the  only  cases  in 
which  any  operation  had  been  done.  There  were  three 
objections  :  (i)  the  gravity  of  the  operation,  (2)  the  danger 
of  wound-infection,  (3)  the  probability  that  the  cord  was 
irremediably  injured,  and  that  no  surgical  interference  would 
make  any  difference  to  it.  These  objections  were  so  strong 
that  the  operation  of  laminectomy — removal  of  the  vertebral 
arches,  at  the  seat  of  fracture,  so  as  to  take  off  pressure  from 
the  cord — had  seldom  been  done,  though  it  had  been  known 
for  more  than  a  century.  So  late  as  1881,  Page  of  Newcastle 
had  said,  '  It  has  made  no  progress  in  surgery,  nor  is  it 
likely  to  do  so  :  it  is  an  operation  not  within  the  range  of 
practical  surgery.'     No  surgeon  could  think  hghtly  of  its 


FROM  1885  TO  1887  127 

difficulties  and  risks  :  and  the  best  of  surgeons  might  well 
dread  the  responsibility  of  doing  it  for  the  lii-st  time.  It  was 
essentially  an  operation  which  needed  to  be  studied  on 
animals  :  but  the  Act  of  1876  had  made  it  a  criminal  offence 
for  anybody  to  experiment  on  a  vertebrate  animal  for  the 
purpose  of  attaining  manual  skill.  No  precise  rules  had  been 
formulated  for  dealing  with  the  special  difficulties  of  the 
operation. 

But  Horsley,  by  1887,  had  already  done  the  operation,  in 
the  course  of  his  work  with  Beevor,  on  animals.  And  he 
had  done  it  under  the  conditions  which  were  present  in  this 
patient's  case  ;  the  conditions  of  operating,  through  un- 
injured muscles  and  bone,  on  the  cord.  He  had  got  his 
method  ready-made,  he  had  worked  it  all  out,  every  step  and 
stage  of  it.  Even  with  these  safeguards,  the  operation  was 
of  the  utmost  anxiety  ;  the  tumour  was  very  small,  and  lay 
higher  in  the  spinal  canal  than  had  been  expected  ;  and 
Horsley  hesitated  to  extend  the  wound  further.  Sir  Charles 
Ballance,  who  was  assisting  him,  urged  him  to  extend  it  : 
and  the  tumour  thus  was  exposed  and  removed.  The 
wound  healed  well.  The  patient,  a  year  later,  repf)rt('d  that 
he  was  in  excellent  health,  and  had  done  a  sixteen-hours  day's 
work,  with  much  standing  and  walking.  The  tumour  was  of  a 
kind  which  does  not  recur  :  he  remained  well  up  to  the  time 
of  his  death  from  another  cause,  some  twenty  yeai^s  later. 

At  the  end  of  his  account  of  the  case,  Horsley  gives  a  list, 
from  British  and  foreign  text-books  and  journals,  of  fifty- 
eight  recorded  cases  of  tumour  of  the  cord.  With  charac- 
teristic thoroughness,  he  tabulates  each  case  under  no  less 
than  twenty-seven  headings.  In  twenty  cases,  the  tumour 
wiLS  extra-dural,  i.e.  outside  the  sheath  of  the  cord  :  in 
thirty-eight  cases,  it  was  intra-dural.  The  list  is  full  of 
hopeless  misery.  '  For  all  the  horrible  sufferings  of  the 
fifty-eight  cases,  in  only  two  was  any  treatment  of  avail.' 
One  was  his  patient  (intra-dural)  :  in  the  other  case,  some 
relief  was  given,  for  a  short  time,  by  the  removal  of  part 
of  a  large  extra-dural  tumour.  But  of  fifty-eight  |)atients, 
fifty-six  died  without  any  help  from  surgery,  after  pro- 
tracted and  severe  suffering. 


128  SIR  VICTOR  HORSLEY 

In  these  years  of  his  hfe,  he  took  no  long  hohdays  :  but 
Mrs.  Gotch  remembers  a  Uttle  holiday  of  this  year,  1887,  a 
boating  expedition  down  the  Avon,  from  Stratford  to 
Gloucester  : 

He  was  always  in  his  element  on  these  expeditions,  full  of 
energy  and  resource,  of  delight  in  the  country  and  the  open- 
air  life  ;  of  interest  in  the  little  old  inns  wliere  we  put  up 
for  the  night ;  and  untiringly  exploring  the  churches  and 
villages  which  we  passed. 

Of  such  holidays  as  these,  Sir  Edward  Schafer  writes  : 

I  have  been  looking  through  old  diaries  of  the  eighties, 
in  which  mention  is  made  of  many  expeditions — on  the  river 
and  elsewhere — in  which  Victor  Horsley,  and  later  Eldred 
Bramwell,  were  constant  ingredients :  and  I  may  add 
Frank  Gotch  and  Rosamund  Horsley — indeed  the  two 
engagements  crystalhzed  out  under  these  watery  condi- 
tions. Many  incidents  are  recalled  by  the  short  entries 
giving  dates  and  places  and  personnel.  On  one  occasion, 
when  we  were  passing  along  a  canal  with  enormous  locks 
and  no  lock-keepers,  we  were  nonplussed  by  having  no  lock- 
key.  Victor  insisted  on  trying  to  manufacture  one  with 
a  pocket-knife  out  of  a  fence-post  :  and  was  quite  annoyed 
with  Frank  Gotch  and  myself — the  other  members  of  the 
partj^ — because  we  insisted  on  buying  a  key  from  a  passing 
barge,  instead  of  waiting  for  him  to  finish  the  manufacture  : 
although  I  think,  if  we  had  waited  for  a  key  made  in  his 
way,  we  should  still  be  there  !  On  another  occasion,  when 
I  was  taking  a  walk  with  Victor  in  the  Lake  District — 
and  a  very  strenuous  one  it  was — he  spent  the  whole  time 
we  were  resting  (!)  on  the  summit  of  Scafell  Pike,  in  endeav- 
ouring to  bury  under  cainis  the  evidences,  in  the  shape  of 
paper,  left  by  previous  travellers  who  had  picnicked  there  : 
but  the  task  proved  too  Herculean  even  for  him.  The 
amount  of  superfluous  energy  he  possessed  would  have  been 
sufficient  to  endow  six  ordinary  people  :  and  what  is  extra- 
ordinary, the  expenditure  of  it,  instead  of  wearing  him  down 
to  a  premature  senihty,  kept  him  in  a  perpetual  state  of 
juvenility  :  I,  at  any  rate,  never  knew  any  man  who  re- 
mained so  long  young  or  showed  evidences  of  age  so  httle. 

On  Sc^ptembcr  26,  1887,  Horsley  writes  from  the  Brown 
Institution  to  Semon,  about  their  work  together  :  and  at 
the  end  of  the  letter  he  says,  '  I  do  so  look  forward  to  our 
resuming  work  in  the  winter,  when  life  will  be  a  paradise, 
not  the  hell  it  has  been.'     He  and  Miss  Bramwell  had  been 


FROM  1885  TO  1887  129 

engaged  for  four  years  :  he  was  sick  of  waiting.  He  used  to 
say,  in  later  life,  that  the  four  years  had  been  a  waste  of 
time,  not  real  hfe  :  that  they  had  done  nothing  for  him  : 
that  he  had  only  been  marking  time. 

On  October  4,  they  were  married,  at  St.  Margaret's, 
Westminster.  It  was  a  quiet  wedding,  with  very  few 
people  there  :  and  the  hone^^moon  was  delayed,  because  a 
Hospital  patient  was  bringing  an  action  against  an  omnibus 
company,  and  he  might  be  called  to  give  evidence.  Happily, 
the  action  broke  down  :  and  they  went  to  Italy.  He  was 
overworked  and  overtired  when  they  started  :  he  ought  to 
have  planned  a  holiday  nearer  home  :  and  in  Bologna  he 
was  laid  up  with  a  bad  attack  of  appendicitis.  But  marriages 
are  above  romance  ;  which  is  made  on  earth,  but  marriages 
are  made  in  Heaven  ;  and  they  are  made  there,  because 
they  must  be  made  where  the  hearts  and  the  intellects  for 
them  are  made.  Heaven  was  so  pleased  with  this  marriage, 
that  it  made  another,  to  go  with  it :  Frank  Gotch  and 
Rosamund  Horsley  were  married  on  December  15,  1887. 

It  was  at  some  time  after  1887  that  Horsley  devised,  for 
signature  of  his  more  intimate  letters,  his  rebus  of  the 

galloping  horse,  with  its  V-shaped  saddle.  The  little  horse 
never  stood  still  :  it  seldom  trotted  or  cantered  :  it  preferred 
to  gallop.  Now  and  again,  in  his  letters  to  his  wife,  it 
pranced,  or  threw  up  its  heels  :  but  these  antics  were  not 
for  the  world  to  see.  With  his  largest  handwriting,  it  would 
grow  to  near  three  inches  long  :  but  it  was  mostly  a  small 
animal,  but  full  of  energy  :  only,  it  had  an  archaistic  air, 
as  if  it  were  trying  to  look  Uke  the  White  Horse  on  the 
Berkshire  Downs. 


PART    II 

SCIENCE  AND  PRACTICE.     PROFESSIONAL 
POLITICS.     PUBLIC  LIFE 


I 

From  1888  to  1892 

It  was  easy  to  divide  into  chapters  the  record  of  the  years 
from  1857  to  1887  :  but  the  years  from  1888  to  1914  are  not 
so  easily  divided.  In  these  later  years,  without  ceasing  to 
work  for  the  advancement  of  science  and  practice,  he  made 
time  to  give  himself  to  professional  politics,  to  plans  for 
the  improvement  of  the  national  health  and  efficiency,  and 
to  Parliamentary  politics.  These  years,  the  summer  and 
autumn  of  a  life  which  had  no  winter,  cannot  be  kept  in 
strict  order  of  time  :  there  are  interests  m  them  which 
require  separate  chapters.  But  this  and  the  next  three 
chapters  are  concerned  chiefly  with  his  work  for  science  and 
practice. 

1888  {crt.  31) 

On  March  5,  1888,  at  a  meeting  of  the  Medical  Society  of 
London,  Fcrrier  and  Horsley  reported  a  case  of  cerebral 
abscess  '  treated  by  operation,  with  uninterrupted  and 
complete  recovery'  (Proc.  Med.  Soc,  xli.  233).  The  day 
of  the  operation  was  December  10,  1887.  At  this  meeting, 
Horsley  spoke  of  the  treatment  of  septic  thrombosis  of  the 
lateral  sinus,  and  said  that  he  had  already,  in  one  case, 
ligatured  the  sinus  and  removed  the  septic  clot  from  it. 
This  is  the  first,  or  one  of  the  first,  references  in  the  hterature 
of  surgery  to  any  operation  on  the  lateral  sinus. 

In  April,  he  was  appointed  on  a  Parliamentary  Committee 
'  to  inquire  into  and  rcjiort  upon  the  nature  and  extent  of 
pleuro-pncumonia  in  the  United  Kingdom,  and  the  effects 
of  inoculation  and  other  preventive  measures  on  that 
disease  :  also,  to  inquire  into  the  nature  and  extent  of 
tuberculosis  in  the  United  Kingdom,  and  the  means  to  be 
adopted    to    arrest    its   progress.'     Thirty   years   ngo,    the 


134  ^IR  VICTOR  HORSLEY 

protective  inoculation  of  cattle  against  pleuro-pneumonia 
was  a  rough-and-ready  method  in  Australia,  New  Zealand, 
and  South  Africa,  which  was  not  well  thought  of  in  this 
country.  The  whole  study  of  the  diseases  of  cattle  was  very 
different  from  what  it  is  now.  The  detection  of  tuberculosis 
in  cattle  by  the  tuberculin  test  was  unknown  :  tuberculin 
had  not  yet  been  discovered.  The  Committee  felt  them- 
selves able  to  deal  with  these  two  colossal  questions  in  less 
than  three  months  :  their  report  is  dated  July  lo.  There  is 
a  supplementary  report  by  Horsley,  recommending  '  that 
both  the  forbiddal  of  breeding  from  diseased  animals,  and 
the  notilication  of  the  disease  (in  cattle),  should  be  included 
in  any  legislation  for  tuberculosis.' 

On  June  7,  at  a  meeting  of  the  Royal  Society,  Beevor's 
and  Horsley 's  paper  was  read,  '  Note  on  some  of  the  motor 
functions  of  certain  cranial  nerves,  and  of  the  first  three 
cervical  nerves,  in  the  monkey  [Macacus  sinicus).'  See 
Proc.  Roy.  Soc,  xliv. 

In  the  summer  of  1888,  Gotch  and  Horsley  were  working 
together  in  Oxford,  for  their  Croonian  Lecture :  and  in  August 
they  submitted  to  the  Royal  Society  their  preliminary 
paper,  '  Observations  upon  the  electromotive  changes  in  the 
mammalian  spinal  cord  following  electrical  stimulation  of 
the  cortex  cerebri '  (Proc.  Roy.  Soc,  xlv.  18).  Before  1888, 
the  influence  of  the  brain  over  the  movements  of  the  Umbs 
had  been  studied  at  the  beginning  of  its  course,  in  the  cortex, 
and  at  the  end  of  its  course,  in  the  muscles  :  but  there  had 
been  no  study  of  it,  or  next  to  none,  midway  in  its  course,  in 
the  spinal  cord.  Thus,  there  was  no  saving  what  changes 
might  be  imposed  on  it  by  the  cord.  In  a  case  of  epilepsy, 
for  example,  the  convulsive  movements  might  be  decided 
not  only  by  the  brain  but  also  by  the  cord  :  they  might  even 
be  more  of  '  spinal  origin  '  than  of  '  cortical  origin  '  :  there 
are  cortical  centres,  and  there  are  spinal  centres :  and  no 
observation  of  the  movements  of  the  muscles  could  dis- 
tinguish what  might  be  cortical  from  what  might  be  spinal. 
Gotch  and  Horsley  set  themselves  to  this  problem. 

In  order  to  ascertain  what  share  respectively  the  centres 
in  the  cortex,  and  those  in  the  spinal  cord,  have  in  the  pro- 


FROM  1888  TO  1892  135 

duction  of  the  characteristic  epileptic  sequence,  the  action 
of  the  latter  must  be  eliminated.  .  .  .  For  this  purpose, 
we  determined  to  obtain,  if  possible,  evidence  as  to  the 
excitatory  processes  of  the  epileptic  convulsion  in  the  spinal 
cord,  by  '  tapping  '  the  cord  and  noting  the  electromotive 
changes  which,  as  is  well  known,  accompany  functional 
activity  in  nerves. 

They  used  a  capillary  electrometer  :  and  they  studied  the 
cord  at  the  level  of  the  lower  dorsal  region.  That  form  of 
muscular  movement  which  is  called  '  epileptic  '  has  a  well- 
marked  character,  whether  it  occurs  naturally  in  a  case  of 
epilepsy  or  is  produced  experimentally  by  stimulation  of  a 
cortical  centre.  There  is,  first,  a  short  stage  of  uninterrupted 
contraction,  which  is  called  '  tonic  '  :  then,  a  stage  of  in- 
terrupted contraction,  with  jerking  of  the  muscles,  which  is 
called  '  clonic'  If  the  character  of  the  electromotive 
changes  in  the  cord  were  found  to  be  in  keeping  with  this 
twofold  character  of  the  epileptic  movement,  it  would  be 
evidence  that  the  movement  was  almost  entirely  of  cortical 
origin.  That  is  to  say,  it  would  be  evidence  that  the  move- 
ment of  the  lower  limb,  induced  by  stimulation  of  the 
surface  of  the  brain,  was  hardly  modified  by  the  spinal 
centres  for  the  lower  limb  :  for  these  centres  are  in  the 
lumbar  region  of  the  cord,  below  the  level  at  which  the  cord 
was  being  tested. 

Gotch  and  Horsley  made  out  two  facts  of  great  importance  : 

1.  In  the  lower  dorsal  region  of  the  cord,  i.e.  below  the 
spinal  centres  for  the  upper  limb,  but  above  the  spinal 
centres  for  the  lower  limb,  stimulation  of  the  surface  of 
the  brain  was  followed  by  electromotive  changes  in  the 
cord  if  the  cortical  centres  for  the  lower  limb  were  stimulated, 
but  not  otherwise.  This  rule  was  invariable  :  it  is  a  good 
instance  of  the  strictness  of  the  locahsation  of  function  in 
the  cord. 

2.  The  electromotive  changes  in  the  lower  dorsal  region 
of  the  cord,  which  attended  nervo-impulscs  passing  from 
the  surface  of  the  l^rain  to  tlic  hnver  limb,  were  in  kccjiing 
with  the  twofold  character  of  the  movement  of  tliat  limb  : 
that  is  to  say,  they  gave  evidence  of  their  cortical  origin  ; 
and  the  capillary  electrometer  registered  this  evidence. 
'  The  electromotive  change  was,  first,  a  persistent  stage, 
next,  a  rhythmical  stage  :  answering  to  the  tonic  and  clonic 
stages  of  the  convulsion.  .  .  .  \Vc  have  repeated  this  obsor- 


T36  SIR  VICTOR  HORSLEY 

vation  thirty  or  forty  times,  and  feel  ourselves  justified  in 
concluding  that  we  have  obtained  evidence  that  during  a 
cortical  epileptiform  discharge  the  electromotive  changes 
in  the  cord  are  exactly  parallel,  as  regards  the  character 
of  their  sequence,  to  the  convulsions  of  the  muscles  as  re- 
corded by  the  graphic  method.' 

In  the  autumn  of  1888,  the  first  Triennial  Congress  of 
American  Physicians  and  Surgeons  was  held,  in  Washington. 
Horsley  was  one  of  those  who  attended  it  by  special  in- 
vitation, and  a  very  hearty  welcome  was  given  to  him. 
He  took  part  in  a  discussion  '  On  cerebral  localisation  in  its 
practical  relations.'  He  spoke  of  his  work  in  experimental 
physiology — '  These  experiments  have  been  performed  by 
myself  in  conjunction  with  other  observers,  and  therefore 
when  I  refer  to  them  inadvertently  as  my  own  work,  I  beg 
you  to  imderstand  that  I  am  simply  the  spokesman  of  my 
colleagues,  Drs.  Schafer,  Beevor,  Gotch,  and  Felix  Semon.' 
He  reaffirmed  his  theory  of  the  motor  centres,  which  he  had 
submitted  to  the  Neurological  Society  in  December  1886  : 

I  beUeve  that  in  this  so-called  motor  region  we  have  three 
functions  clearly  represented :  (i)  Shght  representation  of 
the  tactile  sensation.  (2)  Representation  of  the  so-called 
'  muscular  sense.'  (3)  Great  representation  of  movement. 
The  evidence  in  favour  of  this  belief  is  both  morphological 
and  physiological.  We  must  beUeve  that  these  three  func- 
tions are  wrapped  up  closely  together,  and  that  in  every 
given  particle  of  grey  surface  there  is  represented  this  triune 
function  for  a  single  segment  of  the  body.  Morphologically, 
we  find  that  the  large  cells  in  the  fourth  layer  are  the  seat  of 
the  representation  of  movement.  I  therefore  cannot  under- 
stand why  we  should  not  give,  to  the  small  cells  of  the  upper 
layer,  the  representation  of  sensation.  The  physiological 
evidence  on  which  this  belief  is  founded  is  both  experi- 
mental and  clinical. 

And  he  went  on  to  speak  of  the  rules  to  be  observed  in  the 
operative  surgery'  of  the  brain. 

By  1888,  also,  he  was  able  to  define  the  operative  treat- 
ment of  those  cases  of  tumour  of  the  brain  in  which  it  is  not 
possible  to  remove  the  tumour.  He  had  proved  that  great 
relief  was  given  by  a  very  free  trephining.  It  lowered  the 
intracranial  pressure,  and  thus  arrested,  or  delayed,  the 
pain,  vomiting,  and  optic  neuritis,  which  are  common  in 


FROM  1888  TO  1892  137 

these  cases.  The  date  of  the  first  of  his  op)erations  of  this 
kind  is  January  1887.  This  palliative  treatment — its  name, 
'  decompression  '  was  given  to  it,  later,  by  Professor  Harvey 
Gushing — is  all  that  can  be  done,  in  very  many  cases :  and 
the  histor}^  of  brain-surgery  is  in  great  part  concerned  with 
the  decision  of  the  question — so  far  as  it  can  ever  be  decided — 
In  what  cases  ought  the  surgeon  to  set  himself  to  remove  the 
disease,  and  in  what  cases  ought  he  to  refrain  from  attempt- 
ing more  than  the  reUef  of  the  intracranial  pressure  ? 


1889-1890 

In  March,  1889,  Walter  Spencer  and  Horsley  pubhshed  in 
the  British  Medical  Journal  their  '  Report  on  the  control 
of  haemorrhage  from  the  middle  cerebral  artery  and  its 
branches  by  compression  of  the  common  carotid.'  The 
middle  cerebral  artery,  or  one  of  its  branches,  is  the  usual 
starting-point  of  a  cerebral  haemorrhage  in  apoplexy. 
Spencer  and  Horsley  exposed  the  artery,  in  the  brain  of  the 
monkey ;  and  found  that  its  blood-supply  was  easily  con- 
trolled by  digital  pressure  on  the  carotid  artery  in  the  neck. 
'  The  vessels  were  not  entirely  emptied :  some  blood  still 
remained  in  them,  but  no  pulsation  could  be  seen  even  in  the 
largest  of  them.  The  cortex  which  the  vessel  supplied 
became  pale.  On  releasing  the  carotid,  pulsation  immedi- 
ately returned,  and  the  colour  of  the  cortex  came  back.' 
If  the  branches  were  divided,  digital  pressure  on  the  carotid 
stopped  the  bleeding  from  them  in  a  few  seconds.  Doubt- 
less, this  method  of  first-aid  treatment  might  be  of  great 
usefulness,  if  it  could  be  given  to  the  patient  at  the  very 
onset  of  the  haemorrhage  :  but,  in  practice,  this  opportunity 
would  hardly  ever  occur.  None  the  less,  the  suggestion  was 
founded  on  observed  facts  ;  and  is  the  only  suggestion  for 
any  really  direct  treatment  of  these  cases. 

In  May,  at  a  meeting  of  the  Neurological  Society,  there 
was  a  discussion  as  to  the  causes  of  the  difference  of  tem- 
perature, in  some  cases  of  injury  to  the  brain,  between  the 
two  sides  of  the  body,  Horsley  spoke  of  eighteen  instances 
of  this  difference  of  temperature,  which  he  had  observed  in 


138  SIR  VICTOR  HORSLEY 

a  period  of  seven  years.  The  problem,  he  said,  could  only 
be  solved  by  experimental  physiology :  meanwhile,  he  was 
averse  from  all  theorising  about '  heat-centres.' 

On  November  7,  he  gave  an  address  to  the  Medical  Society 
of  Owens  College,  Manchester,  '  On  the  diagnosis  of  brain- 
disease.' 

In  June,  1890,  at  a  meeting  of  the  Royal  Society,  Spencer's 
and  Horsley's  paper  was  read,  '  On  the  changes  produced  in 
the  circulation  and  respiration  by  increase  of  the  intra- 
cranial pressure  or  tension.' 

In  August,  1890,  he  demonstrated  and  described,  at  the 
International  Medical  Congress  in  Berlin,  the  chief  results 
of  his  work  in  physiology  with  Schafer,  Beevor,  and  Semon.* 
It  is  certain  that  he,  though  he  was  only  thirty-three  years 
old,  was  one  of  the  most  notable  figures  at  the  Congress  :  as 
it  was  said  of  him,  that  week,  '  Dem  gehort  die  Zukunft ' : 
to  him  belongs  the  future.  He  gave  these  demonstrations 
before  large  audiences  of  physiologists  and  surgeons,  many 
of  them  averse  from  admitting  all  that  he  had  come  to  show 
to  them :  just  as  in  1889,  in  Bale,  when  he  produced  by 
stimulation  one  very  delicate  and  closely  deiincd  move- 
ment, and  heard  over  his  shoulder  a  murmur  from  Goltz, 
'  Es  ist  ganz  wahr ' :  it  is  perfectly  true.  At  Professor 
Waldeyer's  house,  he  arranged  an  exhibition  of  photographic 
studies  of  brains — such  photographs  as  had  never  been  seen 
in  Berlin.  At  a  great  meeting  of  the  Sections  of  Surgery  and 
of  Neurology,  he  gave  an  address  '  On  the  surgery  of  the 
central  nervous  system.'  He  had  operated  on  the  brain  in 
44  cases.  Among  these  44  cases,  there  had  been  10  deaths. 
These  deaths  had  been  mostly  in  cases  of  brain  tumour  of  a 
malignant  nature  (glioma,  glio-sarcoma).  He  had  done  5 
operations  for  cerebral  cyst,  and  6  operations  of  decom- 
pression, without  a  death.  He  had  operated  on  the  spinal 
cord  in  19  cases  :  in  6  of  these,  he  had  opened  the  sheath  of 
the  cord  :   among  these  19  cases,  there  had  been  i  death. 

'  Sir  Feli.x  Semon  writes :  '  Nobody  seemed  to  have  expected  a  demon- 
stration of  that  convincing  character.  .  .  .  Everybody  was  struck  by 
his  extreme  modesty.  To  all  the  corapUments  justly  pjiid  to  him,  he  only 
responded  by  an  amiable  smile,  or  by  disclaiming  any  extraordinary 
merit.' 


FROM  t888  TO  1892  139 

He  was  elected,  this  year,  an  Honorary  Fellow  of  the 
American  Surgical  Association.  This  year,  also,  he  resigned 
his  appointment  to  the  Brown  Institution  :  and  was  ap- 
pointed FuUerian  Professor  at  the  Royal  Institution.  He 
writes,  in  April,  to  a  friend  : 

The  time  has  come  when  I  must  give  up  the  Brown.  I 
can  no  longer  go  such  a  distance,  and  moreover  I  want  to 
devote  myself  to  working  up  my  new  Laboratory  at  Uni- 
versity College.  The  loss  of  the  income,  however,  is  a  very 
serious  point  to  me,  it  being  nearly  ;^300.  The  [Royal  In- 
stitution] Professorship  supplies  a  third  of  this  blank,  and 
when  I  heard  that  Romanes  would  not  apply  for  re-election, 
I  resolved  to  go  in  for  it.  A  hundred  a  year  cannot  be 
disregarded  under  any  circumstances  :  but  for  me  it  becomes 
a  necessity  to  obtain  if  possible  another  chance  of  fixed 
income,  since  as  a  matter  of  fact  I  spend  at  University 
College  the  whole  of  the  fees  I  receive  for  my  classes. 

Strange,  that  he  should  have  to  be  thinking  of  £100  a 
year,  when  his  work  was  teUing  on  science  and  practice  in 
half  a  dozen  countries. 

1891  [cet.  34) 

This  year,  the  house  in  Park  Street  was  wanted  back  by 
its  owner :  and  the  Horsleys  moved  to  33  Seymour  Street  for 
a  few  months — here  their  first  child,  Siward,  was  bom — and 
thence  to  25  Cavendish  Square.  Other  events  of  1891  were 
the  Croonian  Lecture ;  Horsley's  Fullerian  Lectures ;  the 
founding  of  the  Journal  of  Pathology,  with  Sims  Woodhead 
as  editor  ;  and  Horsley's  appointment  to  be  Vice-Dean  of 
the  Medical  Faculty  of  University  College.  He  writes  to 
Schafer,  on  May  11,  '  I  will  endeavour  to  discover  what  are 
the  fimctions  of  a  Vice-Dean  besides  being  vicious.  No 
introductory  for  me,  I  think.  Let  us  have  a  tea-party  and 
side-shows  instead.'  It  was  a  year,  also,  of  much  writing  of 
papers  for  societies  and  journals. 

The  Croonian  Lecture  was  given,  in  abstract,  at  a  meeting 
of  the  Royal  Society,  on  February  26,  1891.  The  full  text 
of  it,  magnum  opus  indeed,  occupies  250  pages  of  the  Trans- 
actions. Gotch  and  Ilorslcy  had  studied  the  passage  of 
nerve  impulses  not  only  between  the  cortex  and  the  cord. 


140  SIR  VICTOR  HORSLEY 

but  between  many  other  levels  of  the  nervous  system  :  they 
give  a  list,  as  follows  : 

Part  exposed  for  Excitation.  Part  exposed  for  Observation. 

Brain  (cortex  and  fibres)       .     Spinal  cord. 

Mixed  nerve. 
.     Spinal  cord  at  another  level. 
Mixed  nerve. 
Spinal  cord. 


Spinal  cord 

Mixed  nerve 
Spinal  roots 
Posterior  roots 


Mixed  nerve. 


The  principal  subjects  which  they  investigated  were  : 

1.  The  resting  electrical  difference  between  the  cut  surface 
and  the  uninjured  longitudinal  surface  of  nerve-fibres. 

2.  The  evidence  of  the  locaHsation  of  function  in  the  cortex 
which  is  afforded  by  electromotive  clianges  in  the  cord. 

3.  The  electromotive  changes,  in  cord  and  nerve,  which 
follow  excitation  not  of  the  cortex  but  of  the  nerve-fibres 
of  the  brain. 

4.  The  various  conditions  under  which  the  electromotive 
changes,  in  cord  and  nerve,  afford  evidence  of  unilateral  or 
bilateral  representation  of  function  in  the  cortex. 

5.  The  degree  of  unilatcrality  of  representation  in  the 
cord  :  and  the  conditions  which  favour  the  spread  of  im- 
pulses from  one  column  of  the  cord  to  another. 

6.  The  paths  in  tlie  cord  along  which  different  impulses 
travel  upward  on  their  way  to  the  brain.  '  By  far  the 
majority  of  afferent  impulses  ascend  the  cord  on  the  same 
side  as  the  entering  root,  both  by  direct  and  indirect  paths  ; 
a  small  minority  ascend  by  the  posterior  column  of  the 
opposite  side ;  and  a  mere  fraction  by  the  lateral  column 
of  the  opposite  side.'  That  is  to  say,  the  frequency  with 
which  each  of  these  paths  was  taken  by  impulses  entering 
the  cord  by  a  posterior  (sensory)  nerve-root,  and  ascending 
the  cord  toward  the  brain,  was  as  follows,  expressed  in  per- 
centages :  posterior  column  of  same  side,  together  with  lateral 
column  of  same  side,  80  per  cent. ;  posterior  column  of  oppo- 
site side,  15  per  cent.;  lateral  column  of  opposite  side,  5  per 
cent. 

7.  The  complete  obstruction  to  all  centripetal  impulses 
which  may  reach  the  cord  by  the  central  end  of  the  anterior 
(motor)  root. 

8.  The  marked  quantitative  diminution,  and  delay,  of 
impulses  lca\ang  the  cord  by  the  anterior  roots. 

9.  The  comparative  effects,  in  a  mixed  nerve,  of  reflex 
excitation  and  direct  excitation. 


FROM  1888  TO  1892  141 

At  the  Annual  Meeting  of  the  British  Medical  Association, 
in  Bournemouth,  he  read  a  paper  '  On  craniectomy  in 
microcephaly.'  Lannclongue  of  Paris  had  recently  devised 
this  operation  ;  the  free  removal  of  one  or  more  areas  of  the 
skull,  in  cases  of  microcephalic  idiocy,  to  lessen  the  pressure 
on  the  brain,  and  thus  to  give  it  some  chance  of  develop- 
ment. Lannelongue  had  done  this  operation  in  two  cases, 
Keen  of  Philadelphia  in  three,  Horsley  in  two  :  one  of  his 
patients  had  been  improved,  the  other  had  died  after  the 
operation,  with  rapid  hyperpyrexia — that  rise  of  the  tem- 
perature to  107°  or  108°  which  occurs  in  some  cases  of  injury 
or  disease  of  the  brain.  In  his  paper,  he  called  attention  to 
this  danger  of  the  operation — that  the  brain,  with  its  im- 
perfect development,  might  fail  to  adapt  itself  to  the  sudden 
change,  and  might  react  in  some  abnormal  way,  leading  to 
death.  Still,  he  was  inclined  to  be  in  favour  of  the  operation 
because  of  '  the  utterly  hopeless  future  that  awaits  these 
cases,'  and  because  the  one  and  only  possibility  of  saving 
them  from  it  was  by  operation. ^ 

At  the  opening  of  the  winter  session  at  University  College, 
he  gave  the  introductory  address,  on  '  The  Student  and  the 
Practitioner ' :  it  is  admirable,  full  of  good  advice  and  good 
feehng. 

On  November  12,  at  a  meeting  of  the  Ophthalmological 
Society,  he  and  Beevor  reported  a  case  of  cerebral  abscess 
in  the  left  angular  convolution,  with  right  hemianopsia 
and  '  word-blindness.' 

In  November,  also,  he  published,  with  Dr.  James  Taylor 

1  A  letter  has  come  (May,  191 7)  from  the  father  of  a  child  on  whom 
Horsley  did  this  operation.  With  the  letter,  were  two  photographs,  one 
of  a  microcephalic  idiot  baby,  the  other  of  a  good-looking  young  officer. 
'  In  the  autumn  of  the  year  1897,  I  took  my  child,  then  about  nine  months 
old,  to  seek  the  doctor's  advice,  the  baby's  forehead  being  contracted, 
there  being  no  fontancUe.  Sir  Victor  strongly  advised  an  operation  :  and 
as  I  was  not  well  off  it  was  a  great  relief  to  me  that  he  never  charged  me 
a  penny  cither  for  the  two  consultations  or  for  the  two  operations  (my 
wife's  brother  and  my  own  brother  being  doctors),  besides  which  he 
gratified  my  wife's  longing  to  be  with  her  child — her  first — by  procuring 
a  private  ward  for  her  at  University  Hospital.  Two  pieces  of  bone  were 
removed  at  an  interval  of  a  fortnight.  The  child  rapidly  recovered.  .  .  . 
He  has  been  a  comfort  to  us  all  our  life.  .  .  .  He  has  been  a  year  in  charge 
of  a  trench  mortar  battery,  and  has  been  especially  cnmmende<l  for 
repelling  a  raid  in  the  trenches.  So  that  I  have  much  to  be  thankful 
for,  that  under  God  I  met  with  Sir  Victor.' 


142  SIR  \'ICTOR  HORSLEY 

and  Dr.  Walter  S.  Colman,  a  long  paper,  '  Remarks  on  the 
various  surgical  procedures  de\ased  for  the  relief  or  cure 
of  trigeminal  neuralgia'  (Brit.  Med.  Joum.,  November  28, 
December  5,  December  12,  1891).  It  is  a  full  historical 
review  of  the  rise  and  advance  of  the  operative  treatment 
of  the  disease.  It  was  published  just  before  he  had  finally 
mastered  the  operation  for  the  complete  removal  of  the 
Gasserian  ganglion.  He  had  made  dissections  for  the  study 
of  this  operation,  some  years  before  :  but  he  was  still  held 
back  by  one  difficulty :  '  for  this  reason,  I  believe  that  the 
complete  removal  of  the  Gasserian  ganghon  is  not  possible.' 
Beside  these  addresses  and  papers,  he  published  : 

1.  On  the  Analysis  of  Voluntary  Movement.  XIX  Century, 
June  1891. 

2.  Die  Function  der  Schilddriise :  eine  historisch-kritische 
Studie.     In  Virchow's  Festschrift,  1891. 

3.  Ueber  den  Gebrauch  der  Elektricitat  fiir  die  Localisi- 
rung  der  Erregungserscheinungen  im  Centralnervensystem. 
With  Professor  Gotch.    Centralbl.  f.  Phys,  January  31,  1891. 

1892   {cBt.  35) 

The  house  in  Cavendish  Square,  which  was  the  Horsleys' 
home  from  1892  onward,  had  been  occupied  by  Dr.  Radchffe, 
a  scholarly  old  physician ;  and,  before  him,  by  Dr.  Brown- 
S^quard.  It  is  a  fine  house,  well  suited  alike  for  entertain- 
ing and  for  a  great  rush  of  home  affairs  :  but  in  the  annals 
of  consulting  practice  it  is  only  the  ground  floor  that  comes 
to  be  described.  His  consulting-room  was  the  front  room 
on  the  ground  floor  ;  it  looked  on  the  Square,  which  is 
pleasant  enough  to  look  at,  when  the  leaves  are  on  the  trees  ; 
it  was  comfortable,  cheerful,  white-walled,  and  neither  too 
large  nor  too  small.  Among  his  belongings  in  it  were  models 
in  yellow  marble  of  temple-columns  in  the  Roman  Forum, 
and  a  very  beautiful  drawing  of  San  Miniato  in  Florence,  by 
Gerald  Horsley  ;  and,  on  the  mantelpiece,  bronzes  from 
Rome,  and  some  treasured  little  casts  of  a  monkey's  brain. 
Opening  into  the  consulting-room,  there  was  a  well-fitted 
dark-room,  for  the  examination  of  the  eye,  ear,  and  throat  ; 
it  is  probable  that  no  other  surgeon  in  London  had  such  a 
good  dark-room.    And  it  is  certain  that  he  was  the  first  of  the 


FROM  1888  TO  1892  143 

Staff  of  University  College  Hospital  to  have  a  telephone  in 
his  house.  In  the  dining-room,  which  was  used  as  the 
waiting-room,  the  chief  picture  was  a  great  photograph  of 
the  Tiber  with  St.  Peter's  and  the  Castle  of  San  Angelo  : 
this  he  had  brought  from  Rome  in  1882.  But  the  pride  of 
the  ground  floor  was  neither  of  these  rooms,  but  the  great 
sky-hghted  room  at  the  back,  which  was  his  workshop. 
Probably  it  had  begim  life  as  a  billiard-room.  He  made  it 
live  up  to  every  inch  of  its  space  and  every  ray  of  its  light. 
Here  in  spare  hours  and  half-hours  he  worked  with  his  hands, 
dissecting,  section-cutting,  photographing  and  developing, 
drawing  and  diagram-making,  and  so  forth.  One  side  of  the 
room  was  taken  up  with  apparatus  for  photography  and 
micro-photography  :  ^  on  the  opposite  side  was  a  lathe  : 
there  was  a  big  stack  of  cartoons  for  lectures,  and  accumu- 
lated photographs  and  negatives,  and  lantern  shdes,  and  his 
coUection  of  thousands  of  microscope  shdes,  and  on  the 
shelves  a  heavy  load  of  notes  and  papers  which  he  did  not 
hve  to  put  in  order.  Always,  he  loved  to  use  his  hands  ; 
he  did  everything  for  himself.  It  was  not  a  private  museum 
that  he  was  making,  it  was  a  records  office  :  he  had  no  love 
of  collecting  for  the  sake  of  collecting :  he  kept  evidences  of 
cases,  just  as  he  kept  notes  of  cases. 

At  the  annual  meeting  of  the  British  Medical  Association 
in  Nottingham,  he  was  President  of  the  Section  of  Pathology ; 
and  spoke  his  mind  against  that  sort  of  pathology  wliich 
hardly  gets  beyond  the  microscoping  and  exliibiting  of 
diseased  organs  : 

However  absurd  the  statement  may  appear  to  some,  I 
venture  to  assert  that  pathology,  as  such,  is  almost  unknown 
among  us.  The  fact  is,  that  what  is  commonly  spoken  of 
as  '  pathology,'  taught  as  '  pathology  '  and  made  the  subject 
of  examinations  in  '  pathology,'  is  nothing  of  the  sort — it  is 
not  pathology,  it  is  morbid  anatomy. 

*  Dr.  MacNalty  writes,  '  I  went  with  him  to  purchase  an  excellent  and 
costly  apparatus  for  micro-pholORraphy  (Zeiss)  ;  and  we  spent  many 
Sunday  afternoons  and  evenings  toRetlier,  takins;  photographs,  developing 
them,  and  trying  the  effect  of  different  coloured  solutions  to  act  ivs  filters 
for  the  electric  arc  light.  His  hands  wore  sometimes  stained  with  chemical 
reagents:  and  a  lady  patient  is  rej>orted  to  have  said,  "  1  hko  Sir  Victor 
Horsley  very  much  ;  but  I  do  wish  ho  would  wash  his  hands  before  he 
comes  to  sec  me."  ' 


144  SIR  VICTOR  HORSLEY 

Suppose  a  student  had  paid  to  be  instructed  in  physiology, 
and  suppose  all  that  his  teacher  did  was,  first,  to  describe 
the  coarse  or  naked-eye  structure  of  the  healthy  body,  next 
its  minute  or  microscopical  structure,  and,  finally,  to  make 
some  crude  guesses  as  to  how  the  various  organs  worked, 
should  we  not  say  that  that  student  had  been  defrauded  ? 
Yet  is  not  this  picture  a  fair  representation  of  what  is  usually 
done  with  pathology  in  this  country  ?  We  have  in  London 
a  society  whose  function,  as  defined  in  its  title,  is  to  promote 
the  study  of  pathology  :  but  unfortunately  it  has  hitherto 
been  only  an  emporium  of  morbid  anatomy.  ...  I  regret 
that  in  the  representative  work  of  the  Pathological  Society 
this  study  should  be  allowed  to  usurp  the  place  of  pathology. 
The  pathologist  should  be  the  student  of  disordered  function, 
as  well  as  of  disarranged  structure.  .  .  . 

What  a  mass  of  facts  has  been  accumulated  in  elucidation 
of  the  various  changes  in  the  structure  of  the  lungs  produced 
by  pneumonia,  phthisis,  etc.  But  how  many  workers  have 
been  found  to  investigate  the  degree  and  effect  of  the  loss 
of  the  respiratory  function,  of  the  disorder  of  the  normal 
oxygen  and  carbonic  acid  ratios  ?  Yet  this  is  what  kills, 
this  is  the  whole  work  of  the  disease  :  and  this  is  what  must 
be  solved  before  the  treatment  of  such  diseases  can  be  worthy 
of  mention  other  than  as  empirical  palliation.  .  .  , 

To  what  are  we  to  ascribe  this  surprising  indifference  to 
pathology  ?  I  have  not  the  sHghtest  hesitation  in  saying 
that  it  is  due  to  want  of  familiarity  with  modem  progress 
in  physiological  and  chemical  research.  Fortunately,  labora- 
tories are  springing  up  now  on  all  sides,  original  investiga- 
tions are  being  pushed  forward,  light  and  knowledge  widely 
diffused.  The  reproach  that  we  have  been  dead-house 
students  rather  than  true  pathologists  will  therefore  soon 
be  wiped  away. 

This  high-handed  criticism  of  the  Pathological  Society 
was  answered  by  Hadden  :  but  the  fact  remains,  that  the 
Society  did  lend  itself  too  easily  to  the  mere  exhibiting  of 
specimens  and  '  card-specimens ' ;  and  some  of  us,  it  may 
be,  were  tempted  to  call  attention  to  our  specimens  for  the 
purpose  of  calling  attention  to  ourselves.  Horsley  had  no 
patience  with  that.  To  him,  pathology  must  be  advanced 
and  guided,  like  physiology,  by  the  experimental  method. 
He  rather  avoided  than  sought  the  older  Medical  Societies  : 
he  preferred  the  new,  exclusive,  less  formal  societies — the 
Physiological,  the  Neurological,  and  the  little  Medical 
Research  Club — which  cared  only  for  work  of  originality. 


FROM  1888  TO  1892  145 

and  were  utterly  opposed  to  anything  commonplace  and 
third-rate.^ 

Early  in  1892,  he  moved  up  a  place  on  the  staff  of  Univer- 
sity College  Hospital;  and  thus  became  assistant-surgeon  to 
Mr.  Christopher  Heath,  and  had  charge  of  the  wards  when 
Mr.  Heath  was  away.  He  also  had  the  night  work  :  for 
Mr.  Heath  did  not  care  for  it.  The  two  men  were  not  well 
suited  to  each  other  ;  they  were  apart  in  age,  and  in  out- 
look ;  strong-willed,  both  of  them ;  and  Mr.  Heath  was  apt 
to  be  in  the  imperative  mood.  There  are  letters  of  1894. 
which  recall  a  frequent  difficulty  of  Hospital  practice.  Mr. 
Heath  writes  : 

I  must  again  ask  you  to  exercise  a  little  more  care  in  send- 
ing patients  into  my  wards.  Last  Monday  I  saw  a  woman 
to  whom  you  had  just  given  an  order  for  immediate  admis- 
sion. ...  As  it  was  clearly  a  case  not  admitting  of  operation, 
I  sent  her  to  the  parish  infirmary. 

To-day  I  find  a  case  of  hernia  admitted  by  your  order 
for  radical  cure,  the  man  being  forty-eight  years  of  age, 
and  no  proper  care  having  been  given  to  fit  a  proper  truss. 
I  have  ordered  a  truss  and  shall  then  send  him  out.  Cases 
of  this  kind  should,  I  think,  be  treated  by  the  out-patient 
surgeon. 

I  shall  be  glad  to  give  notice  at  the  next  meeting  of  the 
Medical  Committee  of  the  following — Mr.  Heath  to  move 
That  all  cases  of  Empyema,  and  Intestinal  Obstruction,  be 
admitted  to  the  medical  wards  in  the  first  instance. 

Horsley  answers  at  once  : 

.  .  .  Personally  I  do  not  think  it  is  proper  treatment  to 
merely  apply  a  truss  in  a  man  aged  forty-eight,  who  being 


'  There  is  a  letter  to  him,  January  1892,  from  E.  H.  HaDkio,  who  then 
was  in  Agra,  organising  the  work  of  chemistry  and  bacteriology  in  tlic 
North-West  Provinces  :  '  1  am  sending  you  a  reprint  of  a  paper  of  mine 
on  alexins.  In  it  you  will  see  that  I  have  returned  to  the  (juestion  of  the 
relation  of  my  work  to  Wooldridge's,  and  have  made  an  attempt  to  justify 
the  view  that  I  have  taken  of  it.  .  .  .  Perhaps  you  will  remember  an 
occasion  at  tiic  Medical  Research  Club,  when  everybody  was  gaily  jump- 
ing on  me,  more  intent  on  proving  their  points  than  on  sparing  my  feelings  : 
and  I  much  hope  that  the  exponmcnt.s  I  have  now  pubhshed  will  enable 
us  to  bury  the  hatchet.  At  present  1  am  more  keen  on  jKJisons  than  on 
bacteriology.  I  have  nothing  to  do  but  medico-lcg:il  work,  and  I  feol 
pretty  sure  that  many  of  the  native  poisons  are  completely  unknown  to 
science.  I  have  a  large  collection  of  them  already,  and  the  only  diUiculty 
is  to  know  which  to  investigate  first.' 

K 


146  SIR  VICTOR  HORSLEY 

healthy  has  presumably  several  decades  of  life  before  him, 
during  which  he  is  constantly  exposed  to  the  risk  of  strangu- 
lation. ...  I  will  arrange  that  your  motion  shall  be  put  on 
the  Agenda  paper  for  the  next  meeting.  Personally  I  am 
not  sure  that  it  is  advisable  to  raise  the  point  for  discus- 
sion in  the  way  indicated,  since  every  one  is  agreed  that 
more  cases  die  from  operation  being  undertaken  too  late 
than  from  any  other  cause. 


In  March,  1892,  he  gave  an  address  to  the  Cardiff  Medical 
Society,  '  On  the  origin  and  seat  of  epileptic  disturbance ' 
(Brit.  Med.  Joum.,  1892,  i.  693).  He  spoke  of  the  experi- 
mental study  of  the  disease,  and  the  work  of  the  Croonian 
Lecture  :  he  demolished  the  old  theory  that  an  epileptic 
fit  is  accompanied  by  '  anaemia  of  the  brain '  :  and  he  was 
unwilling  to  believe  in  epilepsy  of  '  spinal  origin.' 

Much  of  his  time,  in  1892  and  1893,  was  spent  over  the 
preparing  and  giving  of  the  Fullerian  Lectures  at  the  Royal 
Institution  :  he  gave  twelve  lectures  in  1892,  and  ten  in 
1893  ;  all  of  them  on  subjects  related  to  the  nervous  system. 
It  was  no  easy  duty,  with  his  many  other  engagements,  to 
get  through  these  long  courses  of  lectures  ;  he  had  to  range 
far  and  wide  for  subjects  ;  thus,  one  of  the  1893  lectures  was 
on  hypnotism.  Some  of  the  earlier  lectures  were  published, 
in  1892,  in  book  form  :  they  are  good,  but  they  suggest 
Pegasus  in  harness  :  they  do  not  show  the  strength  of  his 
work. 

A  more  notable  piece  of  writing,  this  year,  was  his  long 
paper,  '  Topographical  relations  of  the  cranium  and  surface 
of  the  cerebrum,'  published  in  vol.  vii.  of  the  Cunningham 
Memoirs,  Royal  Irish  Academy,  Dublin,  1892.  It  is,  of 
course,  on  the  lines  of  his  1887  paper  in  the  International 
Journal  of  Medical  Sciences  :  but  he  adds  new  details,  and 
references  to  the  regional  anatomy  of  the  brain  at  different 
periods  of  life. 

In  October,  1892,  at  the  Church  Congress  in  Folkestone, 
he  spoke  in  a  discussion  of  the  question,  '  Do  the  interests 
of  mankind  require  experiments  on  hving  animals,  and,  if 
so,  up  to  what  point  are  they  justifiable  ? '  He  swayed  the 
meeting  to  such  excitement  as  nobody  had  expected  of  it. 


FROM  1888  TO  1892  147 

Miss  Cobbe  had  just  published  her  book,  The  Nine  Circles: 
he  spoke  of  it  as  foUows  : 

I  have  taken  the  trouble  to  collect  all  the  experiments  in 
which  cutting  operations  are  described  as  having  been  per- 
formed by  Enghsh  scientists,  and  in  which  I  knew  anaes- 
thetics to  have  been  employed.  These  experiments  are 
26  in  number.  In  all  of  them  chloroform,  ether,  or  other 
anaesthetic  agent  was  employed.  But  of  these  26  cases, 
Miss  Cobbe  does  not  mention  this  fact  at  all  in  20,  and  only 
states  it  without  quahfication  in  two  out  of  the  remaining 
six.  When  we  inquire  into  these  20  omissions  in  the  26 
cases,  we  find  in  the  original  that  again  and  again  Miss 
Cobbe  has,  in  making  her  extracts,  had  directly  under  her 
eyes  the  words  '  chloroform,'  '  ether,'  '  etherised,'  '  chloro- 
formed,' '  anaesthetised,' '  during  every  experiment  the  animal 
has  been  deeply  under  the  influence  of  an  anaesthetic,'  and 
so  forth. ^ 

He  went  on  to  tell  of  a  certain  Duke,  whose  brother,  at  a 
time  when  rabies  was  about,  was  bitten  by  a  dog :  how  the 
Duke,  though  he  was  a  Vice-President  of  an  anti-vivisection 
society,  had  asked  for  the  use  of  Pasteur's  test  on  a  rabbit. ^ 
PubUc  opinion,  in  the  course  of  the  quarter  of  a  century  since 
1892,  has  come  to  see  the  value  and  the  necessity  of  experi- 
ments on  animals,  and  this  episode  of  the  Folkestone  Church 
Congress  is  of  no  present  interest :  but  Horsley's  speech 
at  the  time  had  great  influence,  and  was  reported  every- 
where. He  pursued  Miss  Cobbe  and  others  into  the  Times, 
and  went  so  far  as  to  call  her  a  bar  ;  Tyndall,  among  those 
who  wrote  to  him,  praised  him  for  '  calling  a  spade  a  spade  '  ; 
and  there  was  a  little  picture  by  George  du  Maurier,  in 
Punch,  of  '  Miss  Fanny  '  and  '  Master  Victor  ' :  the  original 
drawing  was  bought  and  given  to  Horsley  by  some  of  his 
friends.     He  writes  to  Schiifer,  on  October  28,  of  the  closure 

*  Miss  Cobbe  had  said  in  her  preface,  '  So  far  as  it  h.-is  been  possible,  the 
use  or  absence  of  anaesthetics  has  been  noticed  in  regard  to  ah  the  experi- 
ments cited  in  this  book.'  It  was  urj^cd  in  her  excuse,  after  tlie  exposure 
of  the  book,  that  it  had  been  '  compiled  '  not  by  her,  but  for  her. 

*  In  January,  1891,  Horsley  had  written  a  very  pohtc  lellir  to  the  Duke, 
suggesting  that,  as  he  had  consented  to  experiments  on  animals,  he  ought 
to  withdraw  his  name  from  the  anti-viviscction  society — '  On  the  occasion 

of  the  attack  upon  I-ord by  a  presumably  rabid  <log,  you  consulted  mo 

as  to  the  advisability  of  his  lordship  being  treated  by  M.  Pasteur's  mctho<l, 
and  requested  that  inoculation  exiwriments  from  the  body  of  the  animal 
should  Ix;  carried  out  for  you  {to  determine  the  question  of  its  rabidity), 
wluch  was  accordingly  done.' 


148  SIR  VICTOR  HORSLEY 

of  the  correspondence  in  the  Times,  and  of  a  proposal  for  a 
book  about  experiments  on  animals  : 

Oct.  28.  I  personally  do  not  think  it  would  be  well  to 
write  to-day,  or  possibly  under  a  week.  Tlie  reasons  are 
first,  that  I  went  last  niglit  to  the  Times  office  to  meet 
Buckle,  the  Editor,  whom  I  know  well.  Buckle  told  me  that 
he  is  most  an.xious  to  close  the  discussion  altogether,  and  I 
quite  understood  from  him  that  he  would  not  put  in  any 
more  letters  after  mine  of  to-day.  The  next  point  is  that 
the  Association  [for  the  Advancement  of  Medicine  by  Re- 
search] will  bring  the  facts  out  as  soon  as  possible.  They 
are  considering  now  the  offer  received  from  Griffiths  and 
Farran  to  publish  the  work  free  of  cost.  Your  summarised 
statements  would  form  admirably  the  basis  of  the  book. 
Nov.  19.  Frank  Gotch  and  I  propose  to  walk  in  the  Lakes. 
Of  4  Xmas  walks  not  one  has  been  unsuccessful,  and  if  we 
have  snow  the  scenery  is  very  fine.  What  do  30U  say  ? 
I  trust  Yes. 


II 

From  1893  to  1898 

1893  {cet.  36) 

In  January,  Horsley  and  Rubert  Boyce  published  in  the 
British  Medical  Journal  their  '  Preliminary  report  on  oedema.' 
The  old  easy-going  notion  of  oedema  as  nothing  more  than 
a  physical  process,  a  mere  oozing  of  blood-serum  into  the 
tissues  under  mechanical  conditions  of  pressure,  had  been 
disproved  by  Ranvier,  Heidenhain,  and  Wooldridge. 
(Edema  was  the  result  of  the  actions  and  interactions  of 
living  tissues  ;  all  physical  explanations  were  useless : 
the  facts  of  oedema  were  as  complex  as  life  could  make  them  ; 
and  Horsley  and  Boyce  were  able  to  give  a  formidable  list 
of  no  less  than  nineteen  '  divisions  of  the  subject,  on  which 
more  information  must  be  obtained.' 

In  March,  he  gave  a  chnical  lecture  at  Queen  Square, '  On 
paraplegia  as  a  result  of  spinal  caries  (compression-myelitis) 
and  its  treatment'  (CHn.  Journ.,  March  15,  1893).  It  is 
a  reminder,  to  all  students  of  his  life,  that  his  work  for  the 
surgery  of  the  spinal  cord  is  every  bit  as  great  as  his  work 
for  the  surgery  of  the  brain.  In  this  lecture,  he  speaks  of 
those  cases  of  spinal  caries  in  which  the  cord  is  compressed 
(with  paralysis  below  the  site  of  compression)  not  by  de- 
formity of  the  vertebrae,  nor  by  abscess,  but  by  inflammatory 
thickening  of  the  sheath  of  the  cord.  He  showed  five  cases  : 
two  of  inflammatory  thickening,  three  of  abscess  :  all  of 
them  had  improved  since  operation,  and  would  improve 
further  with  more  time.  '  I  would  press  the  advisability 
of  early  resort  to  operation.  I  have  seen  the  most  painful 
deaths  occur  in  these  cases  unrelieved,  when  a  timely  opera- 
tion would  have  saved  their  lives.' 

On  May  18,  at  a  meeting  of  the  Royal  Society,  Beevor's 

Hi 


150  SIR  VICTOR  HORSLEY 

and  Horsley's  paper  was  read,  '  A  further  minute  analj'sis, 
by  electrical  stimulation,  of  the  so-called  motor  region 
(facial  area)  of  the  cortex  cerebri  in  the  monkey  {Macacus 
sinicus).'  They  define  the  centres  for  the  movements  of 
the  face,  the  tongue,  the  soft  palate,  and  the  pharynx  ; 
especially,  they  differentiate  the  centres  for  the  movements 
of  the  lips,  and  of  the  comers  of  the  mouth  :  they  also 
clear  up  a  confusion  in  the  use  of  the  term  '  bilateral  move- 
ment.' 

At  the  Newcastle-on-Tyne  meeting  of  the  British  Medical 
Association,  he  spoke  in  discussions  on  the  treatment  of 
mastoid  disease,  and  on  the  pathology  of  the  thyroid  gland  ; 
and  opened  a  discussion  on  the  treatment  of  cerebral  tumour. 
During  the  seven  years  since  his  first  operation,  he  had 
modified  his  method  :    he  had  changed  the  pattern  of  an 
instrument  ;  he  had  adopted  Bramann's  method  of  applying 
the  antiseptic  gauze  ;  he  had  given  up,  or  was  about  to  give 
up,  the  combination  of  morphia  with  a  volatile  anaesthetic  ; 
and  he  was  performing  the  operation  in  two  stages,  first  the 
removal  of  the  bone,  later  the  removal  of  the  tumour.     He 
had  not  modified  his  principles  ;   he  had  only  strengthened 
them  by  wider  acquaintance  with  cases  kept  for  years  under 
useless  medical  treatment  ;    and  he  said  again,  as  he  had 
said  in  Berlin  in   1890,   that  the  medical  treatment  and 
watching  of  '  suspicious  '  cases  ought  to  be  hmited  to  six 
weeks,  unless  some  notable  improvement  took  place  in  that 
time  :    but  he  would  allow  a  longer  time  for  the  medical 
treatment  of  a  tuberculous  growth  in  the  brain.     The  case 
must  be  judged  '  suspicious  '  from  the  progressive  character 
of  the  symptoms.     '  In  the  first  case  of  cerebral  tumour 
upon  which  I  operated,  there  was  no  optic  neuritis,  no  vomit- 
ing, and  only  some  headache.     The  frequency  of  this  ex- 
emption is  known  to  all  neurologists.     To  wait,  therefore, 
as  is  frequently  done,  for  the  onset  of  optic  neuritis,  vomiting, 
or  headache  is  not  justifiable.'     Finally,  he  spoke  (i)  of  the 
bad  outlook  in  all  cases  of  glioma  or  glio-sarcoma,  (2)  of 
the  great  reUef  given  by  decompression,  (3)  of  the  bare 
chance  that  decompression,  in  this  or  that  case,  may  bring 
about  not  only  relief  of  the  symptoms,  but  actual  retro- 


FROM  1893  TO  1898  151 

cession  of  the  growth.     On  the   first  of  these   points,  he 
said  : 

I  do  not  know  what  may  be  the  experience  of  other  surgeons, 
but  personally  I  have  never  been  asked  to  operate  in  any 
case  of  gUoma  in  which  the  symptoms  had  not  become  so 
marked  as  to  make  it  evident,  or  at  least  suggestive,  that 
very  considerable  infection  had  already  occurred  ;  and  in 
every  case  of  glioma  or  glio-sarcoma  that  I  have  removed, 
the  tumour  has  been  of  such  a  size  as  to  render  it  uncertain 
at  the  time  of  the  operation  whether  or  no  the  complete 
removal  had  been  effected  ;  and  in  all  such  cases  recurrence 
has  ultimately  taken  place.  I  have,  therefore,  in  cases  of 
gUoma  considered  the  question  of  operation  more  from  the 
point  of  palhation  than  cure.  But  that  is  only  because, 
under  the  present  regime,  these  cases  come  far  too  late  to 
the  surgeon  ;  and  until  we  have  a  case  of  gUoma  or  sarcoma 
operated  upon  under  the  same  circumstances  as  it  would 
be  were  the  tumour  situated  in  the  Hmbs  and  not  in  the 
brain,  it  is  ob\aously  quite  illogical  to  draw  conclusions  as 
to  the  curabiHty  of  glioma  from  statistics  drawn  from  the 
cases  at  present  offered  to  the  surgeon. 

This  year,  he  received  from  the  Faculty  of  Medicine  of 
the  University  of  Edinburgh  the  Cameron  Prize,  awarded 
annually  '  to  the  practitioner  or  member  of  the  medical 
profession  who  has  done  most  in  the  past  year  for  practical 
therapeutics  ' :  and  in  December  he  lectured  in  Edinburgh, 
at  the  Oddfellows'  Hall,  on  some  points  in  the  physiology  of 
the  brain  and  of  the  thyroid  gland. 

Other  writings,  in  1893,  were  as  follows  : 

1.  An  Introduction  to  '  The  Chemistry  of  the  Blood,  and 
other  Scientific  Papers,  by  the  late  L.  C.  Wooldridge.' ' 
This  volume  was  edited  by  Horsley  and  Starling. 

2.  The  FuUerian  Lectures  for  1893. 

3.  The  Evening  Lecture  at  the  annual  meeting,  in  Notting- 
ham, of  the  British  Association  :  on  '  The  discovery  of  the 
physiology  of  the  nervous  system.' 

4.  A  post-graduate  lecture  on  '  The  surgical  treatment  of 
nervous  diseases.' 

'  Wooldridge  died  young  ;  he  would  have  become  one  of  the  greatest 
of  our  physiologists.  His  death  was  a  grievous  loss  to  Horsley.  They 
had  stood  against  each  other  for  the  appointment  to  the  Brown  Institu- 
tion :  they  had  worked  together  there  in  close  fncndship.  Horsley 
learned  much  from  Wooldridge,  and  had  the  utmost  regard  for  his  work  ; 
and  to  be  learning  from  men  always  made  Horsley  desire  to  be  in  frieod- 
ship  with  tliem. 


152  SIR  VICTOR  HORSLEY 

On  February  14,  1893,  the  Horsleys'  second  son  was 
bom.^  There  is  a  letter  from  a  grateful  patient  in  Odessa, 
on  whom  Horsley  had  operated  for  trigeminal  neuralgia  : 

The  operation,  which  you  have  so  skilfully  and  artistically 
performed,  is  in  a  very  splendid  state.  I  feel  myself  very 
well,  no  idea  of  neuralgic  pains,  no  dizziness,  neither  deaf- 
ness nor  disease.  The  medical  men  of  Odessa  are  really 
astonished  by  my  present  state  of  health,  and  they  admire 
'  la  finesse  '  of  your  operation.  Receiving  the  '  Graphic,' 
as  a  voice  of  my  friendly  England,  I  was  happy  to  read  a 
short  notice  about  your  lecture  concerning  hypnotism. 
Another  new  incident  occasioned  to  my  whole  family  a 
shouting  sensation  and  cheers — Imagine  yourself,  dear 
Professor,  what  a  noise  could  be  made  if  there  took  part  a 
chorus  of  my  seven  children  and  five  others  with  papas  and 
mammas.  I  proposed  a  cheer  for  Mr.  and  Mrs.  Horsley, 
their  first  and  second  son  1  God  grant  you  and  your  lady 
and  children  a  happy  and  a  long  life  ;  you  are  and  you  will 
be  our  dearest  friend,  and  we  shall  never  forget  your  kindness. 


1894  {cBt.  37) 

Two  signal  honours  came  to  him  this  year :  (i)  The 
Royal  Society  awarded  to  him  one  of  its  gold  medals,  '  for 
his  investigations  relating  to  the  physiology  of  the  nervous 
system,  and  of  the  thyroid  gland,  and  to  their  applications  to 
the  treatment  of  disease.'  (2)  The  University  of  Halle,  at 
its  bicentenary  festival,  gave  him  the  honorary  degree  of  a 
Doctor  of  Medicine. 

He  began,  this  year,  a  long  series  of  experiments,  with 
Dr.  Butler  Harris,  on  a  wholly  new  subject  in  physiology  : 
the  estimation  of  the  oxidising  power  of  the  several  tissues 
of  the  body. 

In  brain-surgery,  he  published  (i)  his  lecture  at  the 
Royal  Institution,  April  6,  '  On  the  destructive  effects  of 
projectiles  ' ;  (2)  his  paper  in  the  Quarterly  Medical  Journal, 

»  Captain  Oswald  Horsley,  M.C.  (and  bar),  Gordon  Highlanders.  Edu- 
cated at  Bcdale's  School,  and  at  Christ  Church  :  received  liis  Commission, 
November  1914  :  thrice  wounded  :  joined  Royal  Flying  Corps  in  August 
191 7  :  promoted  flight-commander,  March  1918  :  killed,  while  flying,  by 
a  failure  of  his  machine,  August  19,  1918.  He,  like  his  father,  had  a 
wonderful  power  of  drawing  men  to  liimself :  wherever  he  was,  at  school, 
at  Oxford,  in  training  at  Aberdeen,  or  on  active  service  in  France,  men 
remember  the  charm  of  his  presence  and  of  his  influence. 


FROM  1893  TO  1898  153 

July,  '  On  the  mode  of  death  in  cerebral  compression,  and 
its  prevention.' 

These  two  writings,  and  the  paper  by  him  and  Spencer,  in 
1890,  on  intra-cranial  pressure,  ought  to  be  taken  together  : 
they  are  concerned,  all  three  of  them,  with  the  evidences 
that  in  death  either  from  disease  or  from  injury  of  the  brain, 
the  failure  of  respiration  precedes,  not  follows,  the  failure  of 
the  heart. 

The  paper  in  the  Quarterly  Medical  Journal  begins  with 
an  account  of  the  experimental  studies  of  this  subject  by 
Leyden,  Leonard  Hill,  and  others  :  then  it  comes  to  the 
question.  What  is  to  be  done  ?  Sudden  death  is  frequent, 
among  cases  of  cerebral  timiour,  haemorrhage,  or  inflamma- 
tion :  there  is  increased  intra-cranial  pressure  in  all  of  them  : 
and  it  arrests  the  breathing  before  it  arrests  the  heart. 
Horsley  writes  of  four  cases  of  cerebral  tumour.  In  one, 
the  patient  had  died  suddenly  in  bed,  a  few  hours  before 
the  time  fixed  for  operation.  In  the  other  three  cases,  the 
operation  had  just  been  begun  : 

Since  the  clinical  picture  of  this  alarming  accident  was 
precisely  the  same  in  each  case,  one  description  will  serve 
for  the  three  instances. 

The  patient  had  been  successfully  anaesthetised,  placed 
on  the  operation  table,  the  head  suitably  arranged,  and  the 
skin-flap  and  superficial  tissues  removed  from  the  bone. 
In  one  the  trephine  had  already  been  applied  for  a  few 
seconds,  in  the  others  not,  when  the  patient  suddenly  turned 
very  white,  the  respiration  became  extremely  shallow  for 
a  few  breaths,  and  then  stopped  altogether.  In  each  case 
artificial  respiration  was  immediately  commenced,  and 
while  it  was  going  on  the  skull  was  opened  very  freely  in 
a  few  minutes,  as  quickly  as  possible,  with  the  trephine  and 
bone  forceps,  and  in  each  case  over  the  presumed  situation 
of  the  tumour.  ...  In  every  instance,  directly  the  skull 
was  adequately  opened,  and  the  pressure  relieved,  normal 
respiration  returned,  the  movements  being  naturally  a  little 
shallow  at  first,  but  soon  assuming  their  customary  pro- 
portions. 

In  these  cases  the  arrest  of  respiration  would  have  been 
inevitably  fatal,  as  has  been  the  result  in  other  cases  of  which 
I  have  been  infonncd,  where  the  patient  either  died  on  the 
tabic,  or  as  soon  as  artificial  respiration  was  stoi)peii.  A 
very  striking  instance  of  prccibcly  the  same  event,  and  of 


154  SIR  VICTOR  HORSLEY 

the  recognition  of  the  true  state  of  things  by  the  operating 
surgeon,  is  a  case  of  cerebral  abscess,  pubUshed  by  Mr. 
Jalland  in  the  Lancet,  where  during  exposure  of  the  abscess, 
the  patient  having  stopped  breathing,  he  punctured  the 
brain,  and  witnessed  the  gratifying  return  of  respiration  in 
proportion  as  the  pus  flowed  out. 

He  goes  on  to  speak  of  certain  cases  not  of  disease  but  of 
sudden  injury  to  the  brain  : 

The  class  in  question  is  that  in  which  a  patient  receives 
a  violent  blow,  frequently  in  the  occipito-temporal  region, 
e.g.  from  a  fist  or  cricket-ball,  or  from  an  explosion,  and 
in  which  the  person  struck  falls,  as  is  stated,  dead.  In 
these  instances  we  do  not  observe  that  any  attempt  is  made 
to  do  artificial  respiration,  although  this  is  just  a  measure 
which  is  universally  taught  in  ambulance  classes,  and  can 
be  practised  properly  by  any  intelligent  layman.  In  all 
probabiUty  these  have  always  been  considered  to  be  deaths 
by  heart  failure,  but  they  are  as  certainly  deaths  from  respira- 
tory arrest,  a  fact  which  can  be  proved  experimentally  on 
the  lower  animals,  with  unfaiUng  accuracy. 

Dr.  Kramer  and  myself  have  recently  shown  precisely  the 
same  to  be  the  pathological  explanation  of  sudden  death 
from  bullet-wounds  of  the  cerebral  hemispheres. 

This  long  series  of  experiments,  with  Dr.  S.  P.  Kramer 
of  Cincinnati,  was  made  during  1893  :  toward  the  end  of 
that  year,  Horsley  read  a  paper,  at  a  meeting  of  the  Liver- 
pool Medical  Institution,  '  On  the  cause  of  death  from  bullet- 
wounds  of  the  cerebral  hemispheres  '  :  on  March  15,  1894, 
at  a  meeting  of  the  Royal  Society,  a  paper  by  Kramer  and 
Horsley  was  read :  and  on  April  6,  Horsley  gave  his  lecture 
at  the  Royal  Institution. 

It  is  characteristic  of  him,  that  he  was  quick  to  find  the 
meaning  in  surgery  of  facts  which  had  been  put  on  record 
without  reference  to  surgery  :  he  went  over  great  stretches 
of  published  science  as  a  man  goes  over  the  ground  with  a 
divining-rod.  Experiments  had  been  made  and  published, 
before  1893,  on  the  effects  produced  on  non-hving  structures 
by  the  firing  of  bullets  into  them  :  none  had  been  made  on 
the  physical  effects  of  a  bullet-wound  of  the  brain  during  life. 
He  therefore  not  only  repeated  these  earher  experiments,  but 
added  to  them  a  series  of  experiments  of  an  altogether  new 


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FROM  1893  TO  1898  155 

kind  :    and  his  lecture  at  the  Royal  Institution  gives  an 
account  of  the  whole  output  of  his  work  on  this  subject. 

He  begins  by  clearing  away  the  old  idea  that  the  '  wind  of 
the  shot ' — the  air  compressed  in  front  of  the  projectile, 
which  Boys  had  made  visible  in  a  photograph  of  a  flying 
bullet — has  any  destructive  effect.  In  the  first  place,  it 
exerts  very  feeble  pressure,  as  tested  by  a  dehcate  vane  ; 
and  in  the  second  place  it  is  certainly  easily  reflected  from 
surfaces  of  but  moderate  density.  Nor  does  the  rotation  of 
the  bullet,  nor  the  heat  of  it,  have  any  destructive  effect. 
What  does  destroy  the  tissues  is  the  sudden  rise  of  fluid 
pressure  in  them.  Huguier  had  recognised  this  fact,  after 
the  fighting  in  Paris  in  1848  :  '  it  will  be  remembered  that 
in  that  struggle,  as  in  others,  the  appearance  of  bursting 
within  the  tissues  was  very  noteworthy,  and  gave  rise  to 
the  notion  of  explosive  bullets  having  been  employed  by  the 
combatants.'  Huguier  had  fired  into  dead  organs — lung, 
hver,  etc.,  which  have  much  fluid  in  them — and  had  con- 
vinced himself  that  '  the  energy  of  the  moving  projectile 
being  imparted  to  the  particles  of  water  caused  the  dis- 
persion of  these  in  a  hydrodynamic  fashion.'  Kocher,  in 
1874-76,  by  many  experiments,  had  proved  the  truth  of  this 
theory  of  hydrod3mamic  action  :  that  not  the  bullet  but 
the  tissues  are  explosive. 

Kocher's  experiments  had  been  made  with  the  Vetterli 
rifle  :  Horsley's  were  made  with  the  '303  rifle,  which  had 
lately  been  introduced  into  the  services  :  and  Sir  Andrew 
Noble  had,  at  his  request,  provided  him  with  a  22-calibre 
rifle  modified  to  fire  a  40-grain  bullet  at  any  set  velocity  from 
a  few  hundred  to  3500  feet  per  second.  He  experimented 
with  clay,  with  doughs  containing  known  proportions  of 
water,  with  canisters  filled  with  dry  or  wet  hnt  ;  with  skulls, 
and  with  bullets  fired  through  water.  To  get  permanent 
records  of  the  effect  of  firing  bullets  into  masses  of  clay,  he 
took  plaster  casts  of  the  explosion  cavities  :  these  famous 
casts  are  now  (July  1918)  in  the  War  Museum  of  the  Royal 
College  of  Surgeons.  This  long  scries  of  experiments  on 
non-living  structures  made  it  plain  that  Huguier,  and 
Kocher  after  him,  were  right  :  that  the  effects  of  a  pcnetrat- 


156  SIR  VICTOR  HORSLEY 

ing  bullet-wound  of  the  head  must  of  necessity  be  (i)  a 
slight  increase  of  intra-cranial  pressure,  by  depression  of  the 
fracture  of  the  skull :  followed  immediately  by  (2)  a  very 
great  increase  of  intra-cranial  pressure,  a  hydrodynamic  ex- 
plosion, most  marked  on  the  side  of  entry,  and  so  powerful 
that  it  might  even  disrupt  the  skull. 

To  these  experiments  in  physics,  he  added  a  long  series  of 
experiments  on  animals  under  anaesthesia.  He  proved  that 
the  infliction  of  a  bullet-wound  of  the  brain  was  followed, 
first,  by  complete  arrest  of  respiration,  and  slight  fall  of  the 
central  blood-pressure,  with  consequent  slight  fall  of  the 
peripheral  blood-pressure.  From  five  to  ten  seconds  later, 
there  came  a  remarkable  rise  of  the  blood-pressure,  till  it 
was  even  above  the  normal : 

These  observations  prove  beyond  doubt  that  the  first 
cause  of  death  is  not  what  it  is  usually  supposed  to  be,  and 
as  taught  in  the  text-books,  namely,  arrest  of  the  heart, 
and  syncope  :  since,  as  you  see,  the  heart  goes  on  beating 
although  the  respiration  has  completely  stopped.  Further- 
more, if  we  quickly  perform  artificial  respiration,  we  obtain 
recovery  from  the  otherwise  fatal  arrest.  This  suggests  very 
strongly  that  the  police  and  persons  who  are  trained  in 
giving  first  aid  to  the  wounded  should  be  taught  that,  with 
a  gunshot  wound  of  the  cerebral  hemispheres,  the  proper 
thing  to  do  is  to  employ  artificial  respiration  rather  than 
the  giving  of  stimulants,  etc.  But,  as  you  may  well  expect, 
the  matter  does  not  end  here,  nor  is  it  so  very  simple. 

Anaemia  of  the  brain,  or  pressure  from  haemorrhage  into 
the  brain,  would  tend  to  make  artificial  respiration  useless. 
Still,  the  fact  holds  good,  which  Horsley  first  worked  out, 
that  the  respiration  fails  before  the  circulation.  Some  years 
ago,  a  man  called  on  Dr.  Shuter  of  Chiswick,  complaining  of 
sleeplessness  and  nervousness.  He  had  been  drinking,  and 
was  strange  in  his  behaviour  :  and  by  and  by  he  pulled  out 
a  revolver.  Put  thai  down,  said  Dr.  Shuter  :  the  man  fired 
at  him,  then  turned  the  revolver  to  his  own  head,  and  shot 
himself,  and  feU.  Dr.  Shuter  at  once  did  artificial  respira- 
tion ;  but,  as  Horsley  says,  '  the  matter  is  not  so  very 
simple  ' ;  and  the  man  did  not  come  back  to  life.  But  there 
is  a  well-known  case — not  of  injury  but  of  disease  affecting 


FROiM  1893  TO  1898  157 

the  brain — in  which  the  patient's  life  was  saved  by  this 
method  :  and  a  very  vahiable  hfe  it  is. 


1895  {at.  38) 

Three  honours,  this  year  :  (i)  He  was  made  a  Correspond- 
ing Member  of  the  Societe  de  Chirurgie  de  Paris.  (2)  The 
membership  of  the  Athenaeum  was  given  to  him,  without 
ballot.  (3)  At  the  end  of  the  year,  the  Fothergillian  Prize 
was  awarded  to  him  by  the  Medical  Society  of  London. 

In  Februar}',  at  a  meeting  of  the  Newcastle-on-Tyne 
Clinical  Society,  he  read  a  paper  '  On  oxidation  in  the 
tissues  '  :  an  accoimt  of  the  experiments  which  he  and 
Dr.  Butler  Harris  had  made,  by  Ehrlich's  method,  on  the 
oxidising  or  reducing  powers  of  various  tissues  of  the  body, 
as  shown  by  their  influence  on  methylene-blue  injected  into 
a  vein. 

In  March,  he  gave  evidence  in  a  legal  action  over  Harness's 
'  electric  belts ' ;  and  lectured,  at  the  Royal  Institution,  on 
electrical  currents  in  the  living  body.  He  said  that,  though 
the  construction  of  a  scientific  basis  for  medical  electricity 
was  not  yet  very  far  advanced,  it  was  none  the  less  in 
progress :  '  the  chief  need  was  for  more  investigators,  and 
for  more  general  sympathy  with  a  branch  of  medical  treat- 
ment which  had  hitherto  been  somewhat  unfortunate, 
owing  to  the  manner  in  which  it  had  been  exploited  by 
ignorant  pretenders.' 

In  July,  he  published  a  paper,  in  the  Practitioner,  on  '  Five 
cases  of  leontiasis  ossium,  in  three  of  which  the  disease  was 
removed  by  operation.' 

But  his  chief  contribution  to  surgery,  this  year,  was  at 
tlie  annual  meeting,  in  London,  of  the  British  Medical 
Association  :  '  On  seven  cases  of  injury  or  disease  of  the 
cervical  vertcbrtX-  treated  by  laminectomy.'  This  address 
was  of  the  more  importance,  because  interference  with  the 
cervical  part  of  the  spine  had  rightly  been  judged  more 
hazardous  than  interference  with  the  dorsal  or  the  lumbar 
part.  Of  these  seven  patients,  one  had  died,  not  from  the 
operation,  but  four  months  after  it,  and  a  month  after 


158  SIR  VICTOR  HORSLEY 

leaving  the  Hospital.  At  the  meeting  of  the  British  Medical 
Association  the  year  before,  in  Bristol,  Mr.  Alfred  Parkin  had 
spoken  very  hopefully  of  the  operation,  and  had  reported 
six  cases  :  but  in  only  two  of  them  had  the  operation  been 
on  the  cervical  part  of  the  spine  :  and  the  general  opinion  of 
the  meeting  had  not  been  hopeful  of  much  gain  from  inter- 
ference in  that  region.  Three  of  Horsley's  patients  attended 
the  London  meeting,  and  displayed  their  powers  :  '  it  was 
hard  to  believe,'  says  a  medical  journal,  '  that  when  they 
came  under  Mr.  Horsley's  care  they  were  paralysed  in  all 
four  limbs.' 

In  October,  he  gave  the  introductory  address  at  the  open- 
ing of  the  winter  session  of  the  Sheffield  Medical  School. 
He  told  the  students  that  their  calling  was  '  at  once  the 
most  difficult  and  the  most  straightforward  ;  the  most  re- 
sponsible and  the  most  interesting  ;  the  most  discussed  and 
the  least  understood  of  all  professions.'  He  told  them  that, 
so  soon  as  they  had  passed  their  final  examination,  they 
ought  either  to  assist  a  good  general  practitioner  for  six 
months,  or  hold  a  Hospital  appointment,  or  travel.  Then 
he  spoke  of  drawbacks  in  practice  ;  of  unfair  competition, 
of  touting  and  bullying  '  Medical  Aid  Associations,'  and  of 
quacks — '  the  wretches  who  rob  the  ignorant  not  only  of 
their  wealth  but  of  what  is  beyond  price,  their  health.' 
Finally,  he  spoke  of  the  British  Medical  Association,  the 
Medical  Defence  Union,  and  the  General  Medical  Council — 
what  had  been  done  to  help  and  protect  the  profession,  and 
what  had  been  left  undone. 

1896  {at.  39) 

His  published  writings,  this  year,  were :  (i)  The  Fother- 
gilhan  Lecture,  on  the  thyroid  gland,  with  special  reference 
to  '  Graves's  disease.'  (2)  A  lecture  at  University  College 
Hospital,  on  traumatic  neurasthenia.  (3)  A  paper  in  the 
Medical  Magazine,  on  the  duties  and  functions  of  the  General 
Medical  Council. 

At  the  Carlisle  annual  meeting  of  the  British  Medical 
Association,  there  was  much  hostile  criticism  of  the  General 
Medical  Council,  by  him  and  others. 


FROM  1893  TO  1898  159 

At  the  opening  of  the  winter  session,  he  gave  the  intro- 
ductory address  at  Yorkshire  College,  Leeds  :  it  is  in  part 
concerned  with  the  praises  of  chemistry  as  a  foundation  of 
all  medical  teaching. 

Another  event  of  1896  was  his  resignation,  in  February, 
of  the  Professorship  of  Pathology  at  University  College  ; 
he  no  longer  had  time  for  the  systematic  lecturing.  Before 
him,  Bastian  had  been  Professor,  and  had  given  the  lectures  ; 
Horsley  had  been  Assistant-Professor,  and  had  taught  the 
practical  class.  When  he  succeeded  to  Bastian,  he  had 
rearranged  the  department,  making  it  more  convenient  for 
research  work  in  pathology  and  bacteriology ;  he  had 
published  its  Reports,  in  fine  style  ;  and  he  had  instituted 
a  sub-department  of  pathological  chemistry,  under  Dr. 
Vaughan  Harley.  The  Professorship  had  cost  him  more 
than  it  had  paid  him.     He  writes  to  a  colleague,  February  5  : 

The  fact  that  I  have  run  the  Department  at  a  loss,  and 
that  it  cannot  at  present  be  managed  other%\ase,  is  of  course 
no  credit  to  the  College,  but  I  think  it  is  unavoidable  for  at 
least  some  years  to  come  :  and  that  is  my  reason  for  saying 
that  I  think  it  must  form  one  of  the  possible  conditions 
which  my  successor  would  have  to  contemplate  meeting. 
In  thus  recognising  the  inevitable,  I  do  not  put  the  point 
forward  as  constituting  a  qualification  for  the  post,  only  an 
eventuality  in  which  the  future  professor  will  be  involved, 
and  therefore  one  which  must  be  laid  before  the  candidates. 

It  goes  without  saying,  that  he  had  set  himself,  year  in 
year  out,  to  advanced  teaching.  He  and  Rubert  Boyce, 
the  Assistant-Professor,  had  resolutely  maintained  the  work 
of  the  department  at  a  very  high  level :  too  high  for  any 
student  who  cared  only  to  satisfy  the  examiners.  Dr. 
Charles  Bolton  has  written  : 

When  he  was  appointed  to  the  chair  of  pathology  at 
University  College,  experimental  pathology  was  practically 
non-existent  in  Great  Britain.  Under  Horsley's  directions, 
the  pathological  department  at  University  College  became 
a  di-finitc  and  well-known  centre  for  research  in  experi- 
mental pathology.  He  did  not  teacii  from  the  examina- 
tion point  of  view  in  the  veiy  least  ;  but  his  aim  Wiis  to  give 
an  account  of  the  processes  of  disease  as  ascertained  by 


i6o  SIR  VICTOR  HORSLEV 

experimental  inquiry  :    and  he  illustrated  all  his  statements 
of  fact  by  experiments  on  every  possible  occasion.^ 

On  his  resignation  of  the  Professorship,  his  students  pre- 
sented to  him  a  gift  of  silver,  and  an  album.  Dr.  Sidney 
Martin  was  appointed  Professor.  Horsley  had  supported 
another  candidate,  who,  to  his  thinking,  had  not  been  fairly 
treated  :  and  over  this  more  or  less  imaginary  grievance  he 
went  so  far  as  to  wreck  one  of  the  best  of  all  his  friendships. 

l&xcept  that  he  was  no  longer  called  Professor,  and  was 
freed  from  the  systematic  lecturing,  his  position  at  University 
College  remained  what  he  had  made  it :  he  still  had  his  own 
room,  in  which  he  worked,  and  to  which  he  attracted  men  to 
work  under  him.  Later,  when  the  Medical  School  was 
separated  from  the  College,  a  special  '  Department  of  Ex- 
perimental Neurology  '  was  instituted  for  him  ;  but  this  was 
hardly  more  than  a  convention,  to  keep  him  in  touch  with 
the  School,  and  in  possession  of  his  old  room  behind  the 
anatomy  theatre.  One  of  his  colleagues  has  written  of  these 
later  years  : 

There  he  was  always  to  be  found,  on  certain  afternoons 
in  the  week,  tackling  fresh  problems  with  undiminished 
ardour,  as  the  pages  of  Brain  testify.  None  who  have  ever 
worked  there  under  his  aegis  are  likely  to  forget  his  infectious 
keenness  and  his  unequalled  generosity.  All  that  he  asked 
for  was  that  men  who  came  there  should  be  workers  :  and 
they  did  come,  from  home,  from  the  colonies,  from  America, 
Germany,  Poland,  France,  and  clsewiiere.  It  was  a  matter 
of  indifference  to  him  whether  their  researches  were  pub- 
lished  with   or  without   his   expressed   collaboration ;    aU 

'  He  spoke  of  the  value  of  this  method  of  teaching,  in  his  evidence 
before  the  second  Royal  Commission  on  experiments  on  animals.  He 
chose,  for  a  good  example  to  give  to  the  Commission,  the  demonstration 
on  the  anaesthetised  animal,  of  an  epileptic  fit.  '  I  wish  to  point  out  that 
having  lectured  on  pathology,  and  havmg  illustrated  my  lectures  by 
experiments  on  animals,  the  necessity  of  this  method  has  been  borne  in 
upon  me  very  closely.  As  an  example  I  have  chosen  epilepsy,  with  con- 
vulsions of  all  kinds,  as  being  a  very  common  form  of  disease,  and  yet  one 
which  the  student  has  no  means  of  analysing  in  ordinary  hospital  work, 
and  very  often  hardly  sees  a  patient  in  a  lit  at  all.  And  yet  epilepsy,  for 
instance,  can  be  reproduced  experimentally  with  absolute  fidelity  by  the 
simple  injection  into  the  veins  of  a  drop  of  essence  of  absinthe.  In  twenty- 
five  seconds  you  have  a  typical  epileptic  fit  produced,  and  a  student  who 
has  once  seen  it,  and  watched  it  develop  through  the  body  of  the  animal, 
never  could  forget,  and  never  has  forgotten  it.* 


FROM  1893  TO  1898  161 

recognised  that  he  was  the  leading  spirit  in  the  international 
coterie  that  laboured  in  that  odd-shaped  and  out-of-the- 
way  room,  which  to  many  of  the  younger  generation  of 
neurologists  at  home  and  abroad  was  a  veritable  Mecca. ^ 

Among  the  innumerable  letters  which  he  kept,  there  is 
one,  of  this  year,  from  Hughlings  Jackson,  about  a  case  at 
Queen  Square.     It  brings  us  back  to  practice  : 

I  am  not  clear  as  to  the  deafness  in  the  case.  Consider- 
ing the  great  symmetry'  of  the  paralysis,  I  fear  the  cord  itself 
is  involved.  The  paralysis  is  of  parts  supplied  by  the  4th 
lumbar  and  lower  roots.  (I  got  Beevor  to  see  the  patient  with 
me,  as  Beevor  is  more  famihar  uith  the  nerve-roots  than 
I  am.)  The  man  has  great  pain,  and  the  operation  may 
relieve  this.  If  you  think  there  is  comparatively  little  risk, 
I  shall  be  glad  if  you  will  explore  as  you  suggest,  if  the  patient 
consents.     The  patient  has  yet  to  be  spoken  to. 

This  letter  does  not  stand  alone  :  there  are  many  other 
letters,  from  Hughlings  Jackson  and  from  Gowers,  about 
cases  at  Queen  Square  ;  and  something  comes  to  be  said  of 
them  here.  They  give  the  lie  direct  to  the  gossip  which  was 
talked  against  Horsley — that  he  was  in  a  hurry  to  operate, 
that  he  would  even  operate  for  the  sake  of  operating,  and  so 
forth.  This  brutal  nonsense  had  not  a  word  of  truth  in  it. 
Indeed,  the  only  time  when  Gowers  and  he  had  a  quarrel, 
was  when  Gowers  wanted  an  operation  to  be  done,  and 
Horsley  insisted  on  a  longer  period  of  medical  treatment. 
The  letters  show  the  careful  thought  and  watching  given  to 
the  patients.  The  difficulties  of  exact  diagnosis,  and  the 
difficulties  of  deciding  for  operation  or  against  it,  were  even 
greater  than  those  which  arise  in  general  surgery  :   and  the 


*  Mr.  Wilfrwl  Trotter  writes,  in  the  British  Journal  of  Surgery,  October 
1916  :  '  Year  after  year,  certain  hours  of  the  week  were  regularly  set  aside 
for  the  laboratory,  and  all  who  were  associated  with  him  soon  learned 
that  these  hours  were  to  be  regarded  as  the  most  serious  of  his  engage- 
ments and  the  least  liable  to  be  set  aside  by  other  calls.  When  the 
immense  range  of  other  matters  in  which  he  was  deeply  interested  is  con- 
sidered, it  is  possililc  to  get  .some  idea  of  tlie  strcngtli  in  him  of  this  master 
passion  lor  science,  and  tlic  fortitude  of  the  will  wliicli  could  maintain  it 
against  encroachment  tlirough  more  than  thirty  muUilu<linously  crowded 
years.  Of  all  that  was  accomj)lislicd  in  that  time  no  complete  record  is 
now,  or  perhaps  ever  will  be,  recoverable.  Horsley  was  always  infinitely 
more  interested  in  the  carrying  out  of  his  researches  than  in  tbo  record 
and  publicatioD  of  them.' 

L 


i62  SIR  VICTOR  HORSLEY 

proportion  of  very  grave  cases  was  higher  than  it  is  in 
a  general  hospital.  Of  course,  it  takes  a  doctor  to  read 
between  the  lines  of  these  letters  :  the  references  to  optic 
neuritis,  and  to  the  look  of  the  optic  discs  and  papillae,  will 
not  mean  much  to  non-medical  readers. 

The  letters  from  Gowers — only  a  few  are  given  here — are 
undated.  It  is  not  unhkely  that  the  letters  marked  3  and 
4  refer  to  one  and  the  same  case. 

1.  I  have  a  man  named  Christian  in  the  Hospital,  whom 
I  admitted  after  seeing  him  for  possible  operation  to-morrow. 
But  further  scrutiny  shows  it  cannot  be  yet.  I  should  like 
you  to  see  him.  Don't  let  the  House-physician  say  what 
I  think,  but  form  your  own  opinion.  I  know  you  are  as 
ready  to  change  your  opinion,  if  mine  comes  with  more 
light,  as  you  are  to  take  mine.  Remember  of  this  man 
Christian,  Everley  Taylor  of  Scarboro'  would  come  up 
travelling  through  the  night  to  see  it. 

2.  There  is  a  man  from  Prague,  whom  I  almost  think  you 
introduced  to  me,  and  another  from  Cleveland,  Ohio,  who 
are  anxious  to  see  the  operation,  and  that  on  the  syringo- 
myelia case.  Is  a  notice  of  an  operation  put  up  in  the 
hall  of  the  Hospital  ?  Do  you  object  to  many  spectators 
on  the  benches  ? 

3.  On  the  one  hand,  I  don't  think  the  swelling  of  the 
discs  is  greater.  I  think  the  neuritis  is  subsiding.  If  you 
put  much  weight  on  this,  you  miglit  get  Gunn  to  examine 
them  again.  His  second  more  careful  estimate  quite  con- 
firmed my  opinion  that  the  left  was  the  worse.  On  the 
other  hand,  Purves  Stewart's  case  shakes  rather  my  idea 
of  an  infiltrating  glioma  of  the  pons,  and  makes  me  inclined 
to  think  that  the  probabilities  are  equal  between  that  and 
a  tumour  of  the  right  cerebellar  hemisphere  near  the  pons 
— perhaps  not  far  from  the  seat  in  Stewart's  case.  Have 
you  got  the  reprint  I  asked  him  to  send  you  ?  Later.  That 
cerebral  tumour  case  is  strange.  Never  have  I  seen  such 
rapid  subsidence  of  neuritis.  Of  course  there  has  been 
oedema  as  an  clement,  but  I  think  leucocytes — such  as  we 
find  in  such  immense  quantities  in  the  swollen  papillae — 
must  have  passed  away  by  the  lymphatics  or  vessels.  The 
headache  seems  getting  less,  though  only  slowly.  Still,  I 
cannot  help  thinking  improvement  in  the  growth  may  be 
occurring.  I  have  seen  her  brother,  and  they  are  willing 
and  indeed  grateful  to  keep  her  in.  I  shall  be  glad  to  learn 
your  opinion.  When  you  saw  the  eyes,  the  condition  was 
very  different  from  that  which  existed  when  she  came  in. 
But  it  is  an  ocular  condition  that  may  invalidate  conclu- 


FROM  1893  TO  1898  163 

sions  for  ordinary  cases.  But  see  here ;  if  you  had  trephined 
a  few  days  after  admission,  must  I  not  have  felt  absolutely 
certain  that  a  subsidence,  more  rapid  than  I  had  ever  seen 
before,  was  due  to  the  operation  ?  It  is  a  curious  illustra- 
tion of  danger, 

4.  I  may  not  delay  you  longer  from  doing  what  you  think 
wise  about  that  girl.  The  pain  is  too  severe  :  subsidence  is 
not  maintained.  It  is,  as  to  the  optic  neuritis.  Dismiss 
the  eyes  entirely  from  your  mind  in  considering  the 
question.  That  is  all  I  can  say.  I  am  quite  perplexed  as 
to  the  rest,  and  dare  not  attempt  to  advise  you.  You  will 
understand  that  I  have  waited  to  the  last,  before  saying 
this.  Later.  I  wish  I  had  sooner  withdrawn  my  hindrance. 
That  girl  is  suffering  most  agonising  pain,  and  has  to  be 
kept  under  morphia,  or  she  would  I  think  die  of  pain.  The 
retraction  of  the  head  is  great  when  the  pain  is  on,  and  surely 
this  must  show  subtentorial  disease.  Even  the  nurses  are 
longing  for  Monday  morning.  Later.  I  do  not  remember 
a  case  that  has  grieved  me  so  much.  I  blame  myself  for 
having  hindered  you,  and  then  for  having  biased  you  in 
favour  of  subtentorial  disease.  I  should  think  that  if  ever 
a  Hfe  could  have  been  saved  by  surgery  with  the  utmost 
facility,  it  is  this.  I  wonder  if  you  were  influenced  by  what 
I  said.  I  suppose  you  have  received  my  notes.  I  am  re- 
vising report  of  my  lecture  on  the  case  for  the  Clinical 
Journal.  It  is  one  in  which  there  is  a  moral  compulsion 
to  be  frank,  as  you  will  feel. 

5.  Probably  tubercular.  But  no  good  can  be  done  to 
sight.  Neuritis  is  now  in  stage  of  subsidence  :  but  an 
amount  of  damage  such  as  I  have  never  seen.  Every  nerve- 
fibre  is  destroyed,  and  the  huge  quantity  of  inflammatory 
tissue  will  maintain  the  absolute  destruction,  or  rather, 
would  cause  it  if  it  were  partial  in  degree.  No  inlluence 
on  the  condition  can  possibly  lead  to  any  improvement  in 
siglit.  The  operation  must  be  for  the  pain  alone.  I  was 
going  to  lecture  on  the  case  on  Wednesday,  but  if  you  think 
well  to  operate  to-morrow,  I  will  take  another  subject. 
Lot  it  be  as  you  think  well.     You  may  like  to  wait  a  few  days. 

1897  {(St.  40) 

In  April,  he  was  invited  to  give  the  Cartwright  Lectures 
in  New  York  ;  but  could  not  accept  the  invitation.  In  the 
summer,  he  worked  in  Hamburg  for  two  or  three  weeks, 
on  the  oxidising  power  of  the  tissues.  In  October,  he  was 
elected  to  the  General  Medical  Council.  In  November,  he 
was  appointed  on  the  Senate  of  the  University  of  London. 


t64  sir  victor  HORSLEY 

He  published,  this  year,  (i)  Short  notes,  in  Brain,  on  the 
presence  of  true  Pacinian  bodies  in  muscles,  and  on  the 
survival  of  muscle-spindles  even  in  extreme  atrophy  of  a 
muscle  after  section  of  its  motor  nerve.  (2)  A  paper  at  the 
Medical  Society,  on  traumatic  neurasthenia.  (3)  A  clinical 
lecture  at  Queen  Square,  on  the  diseases  of  the  spinal  cord 
requiring  surgical  treatment.  (4)  An  address  to  the  South- 
West  London  Medical  Society,  on  '  The  Medical  Acts,  as  they 
are  and  as  they  ought  to  be.'  (5)  Das  Sauerstoffbediirfniss 
des  Organismus,  Miinch.  Med.  Wochenschrift,  No.  19,  1897. 
(6)  Blutbefinde  bei  der  intravitalen  Methylenblaumethode, 
ibid.,  No.  23,  1897.  These  last  two  were  in  connection  with 
his  work  in  Hamburg, 

He  also  pubUshed  three  papers,  one  in  physiology  and  two 
in  surgery  : 

1.  '  On  the  relations  between  the  cerebellar  and  other 
centres  (namely,  cerebral  and  spinal)  witli  especial  refer- 
ence to  the  action  of  antagonistic  muscles.'  A  paper  by 
Dr.  Max  Loewenthal  and  Horsley,  read  at  a  meeting  of  the 
Royal  Society,  February  25,  1897. 

2.  '  On  torticollis.'  The  Annual  Lecture  for  1897  to  the 
Hunterian  Society. 

3.  '  On  the  treatment  of  trigeminal  neuralgia.  Two 
clinical  lectures  at  Queen  Square. 

The  operative  treatment  of  torticollis  (spasmodic  wry- 
neck) will  always  be  associated  with  his  name.  He  was  one 
of  the  hrst  surgeons  who  maintained  that  all  such  cases  must 
be  treated  in  strict  accordance  with  the  exact  distribution 
of  the  nerves  to  all  the  involved  muscles  ;  and  that  the 
division  of  the  nerves,  in  severe  cases,  must  be  done  very 
thoroughly,  by  an  extensive  operation,  if  the  patient  is  to 
be  completely  cured.  He  was  not  the  first  of  all  to  work  out 
these  facts.  Risien  Russell  had  determined  them  in  neuro- 
logy by  the  experimental  method ;  and  Gardner  of  Melbourne 
and  Keen  of  rhiladelphia  had  devised  and  performed  the 
new  operation.  Horsley  is  careful  to  reckon  himself  as 
their  follower.  He  had  in  1897  performed  this  '  tedious  but 
very  satisfactory  '  operation  in  five  cases  ;  '  and  certainly 
with  very  gratifying  results  :  in  only  one  did  I  consider  that 


FROM   1893  TO  1R98  165 

the  result  was  not  good.'     Always,  he  regarded  it  as  one  of 
the  most  difficult  of  all  operations. 

The  lectures  on  trigeminal  neuralgia  review  the  whole 
subject  of  this  disease  and  its  surgical  treatment.  In  1891, 
he  had  in  one  case  divided  the  trigeminal  nerve  close  to  the 
brain,  between  the  base  of  the  brain  and  the  Gasserian 
ganglion  ;  but  had  not  seen  his  way  to  the  complete  removal 
of  the  ganglion.  In  1892,  William  Rose,  by  Horsley's  help, 
had  devised  one  method  of  gaining  access  to  it ;  and  Krause 
of  Altona  had  devised  another,  which  Horsley  greatly  pre- 
ferred to  Rose's  method.  In  America,  Hartley  devised  a 
method  very  similar  to  Krause's.  Horsley  added  certain 
improvements  :  his  operation  may  therefore  be  called  a 
'  modified  Krausc-Hartley  operation.'  In  1897,  he  was 
able  to  say,  '  I  have  been  personally  informed  by  Professor 
Krause  that  he  has  done  the  operation  in  thirty  cases  with 
but  one  death.  I  have  myself  done  it  in  eight  cases,  all  of 
which  have  been  healed  without  an  accident.  In  neither 
his  cases  nor  in  mine  has  there  been  any  return  of  pain  so 
far.' 

1898  [cat.  41) 

To  this  year  belong  (i)  A  paper  on  '  The  true  interpreta- 
tion to  be  placed  on  the  Medical  Acts  '  ;  published  as  a 
supplement  to  the  Clinical  Journal,  February  9, 1898.  (2)  A 
paper  in  the  Medical  Magazine,  on  '  The  duties  and  functions 
of  the  General  Medical  Council.'  (3)  A  lecture  on  '  Pene- 
trating wounds  of  the  central  nervous  system  '  ;  published 
in  the  Clinical  Journal.  (4)  A  paper  at  the  Edinburgh 
meeting  of  the  British  Medical  Association,  on  '  The  treat- 
ment of  spinal  caries.' 

In  August,  at  the  meeting  in  Cambridge  of  the  Inter- 
national Physiological  Congress,  Beevor  and  he  read  a  paper, 
'  On  the  excitabk:  fibres  of  the  crus  cerebri.' 

He  succeeded  Sir  George  Savage,  this  year,  as  President 
of  the  Neurological  Society ;  and  gave  a  presidential 
address,  '  A  contribution  towards  the  determination  of  the 
energy  developed  by  a  nerve-centre.'  He  had  advanced 
the  work  of  the  Croonian  Lecture  a  step  further.     Gotch 


i66  SIR  VICTOR  HORSLEY 

and  he,  in  1888,  had  studied  and  measured  the  electro- 
motive changes  which  attend  a  discharge  of  nerve-energy  : 
but  they  had  not  studied  or  measured  nerve-energy  itself : 

When  we  speak  of  the  discharge  of  nerve-energy  from  a 
nerve-centre,  it  is  a  little  disturbing  to  find  that  we  know 
nothing  about  nerve-energy,  except  the  rate  of  its  trans- 
mission along  the  nerve-fibres,  and  the  circumstances  under 
which  it  is  evolved.  It  has  of  course  been  compared  to 
all  forms  of  physical  energy,  and  Newton  himself  speaks  of 
a  nerve  impulse  as  amounting  to  a  vibratory  disturbance 
of  the  particles  of  the  nervous  system. 

To  measure  nerve-energy,  Horsley  measured  the  '  lift '  of 
a  contracting  muscle.  In  this  research,  he  had  the  assistance 
of  Dr.  Veraguth  and  Dr.  Christiansen.  He  states  his  results 
as  follows  : 

No  nerve-centre,  by  any  means  that  I  have  employed  and 
described,  is  capable  of  evoking  as  much  work  from  the 
muscle  as  excitation  of  the  motor  nerve  to  the  muscle  pro- 
duces. The  nerve-centres  do  not  cause  a  complete  explo- 
sion of  the  potential  contractility  of  the  muscle.  Further, 
the  average  '  lift  '  obtained  from  the  cortex  is  about  three- 
fifths  of  that  obtained  from  excitation  of  the  motor  nerve. 


Ill 

From  1899  to  1906 

During  the  next  few  years,  it  was  impossible  even  for  him 
to  give  much  time  to  the  writing  of  scientific  papers.  He 
was  hard  at  work  in  professional  politics  ;  and  he  was  at 
the  zenith  of  his  practice.  The  lists,  in  his  engagement- 
books,  of  consultations  in  London,  and  of  country  journeys, 
are  so  long  that  one  can  hardly  see  how  he  had  time  at 
all  for  science.  By  1904,  professional  politics  were  less 
urgent ;  and  the  output  of  his  writing  came  back  to  full 
strength. 

There  is  a  good  instance,  in  1899,  of  the  range  of  his 
interests  ;  a  lecture  at  the  Royal  Institution,  February  3, 
on  the  Roman  Defences  of  South-East  Britciin.  It  shows 
him  just  as  keen  for  antiquities  as  for  physiology  and 
surgery  and  politics  :  with  knowledge  gained  not  only  from 
books,  but  more  by  observation  and  by  the  use  of  his 
hands.  Lympne,  Pevensey,  Reculver,  Richborough — Partus 
Lenianus,  Anderida,  Regulbium,  Rutapis — their  Latin  names 
are  almost  as  familiar  to  him  as  their  English  :  he  had 
learned  all  about  the  Roman  naval  squadrons,  their  ofhcers, 
and  their  stations  :  the  one  or  two  coins,  and  the  stamped 
tiles,  and  the  cobblestone  paving  which  he  found  at  Lympne, 
all  help  him  to  see  the  place  as  it  was.  At  the  end  of  the 
lecture,  he  describes  the  ruins  of  a  Roman  villa,  excavated  by 
Mr.  Storry,  the  curator  of  the  Cardiff  Museum  : 

On  foliowinf;  up  the  passage,  which  was  the  first  part  of 
the  villa  opened  into,  Mr.  Storry  found  it  led  into  a  large 
room  with  a  good  pavement,  the  tesserae  of  wiiich  were 
broken  and  the  surface  indented  with  horses'  hoofs.  The 
floor  was  covered  by  numerous  human  skeletons,  and  those 
of  horses,  while  in  the  comer  of  the  room  were  the  skeletons 
of  two  children,  and  across,  in  front  of  them,  that  of  a  woman. 

167 


i68  SIR  VICTOR  HORSLEY 

Further,  in  three  graves  dug  in  tlie  floor,  were  found  the 
skeletons  of  men  of  a  larger  and  more  powerful  build  than 
those  whose  remains  were  left  unburied  where  they  fell. 
The  evidence  is  circumstantial  but  complete.  The  whole 
story  is  told.  The  unfortified  dwtlling-house,  the  attack 
by  the  stronger  invaders,  the  retreat  of  the  household  along 
the  passage  to  its  inmost  room,  the  last  stand  of  the  little 
garrison,  the  slaughter  of  the  men,  the  murder  of  the  woman, 
and  last  of  all  the  massacre  of  the  children,  in  front  of  whom 
she  had  thrown  herself  in  a  final  desperate  effort  to  save 
them  from  the  inevitable  destruction.  There  are  those  who 
find  the  study  of  old  walls  dull,  and  wonder  that  some  can 
pore  for  hours  over  a  jaw  from  a  cave,  a  flint  from  a  field, 
or  a  bit  of  Roman  mortar,  but  these  things  arc  the  key 
to  the  unwritten  history  of  man,  and  when  we  find  how 
vivid  a  page  of  history  can  be  restored  to  us  from  the  floor 
of  a  single  house,  one's  wonder  should  rather  be  that  so 
much  still  remains  uncarcd  for  and  unread. 

In  surgery,  this  year,  he  published  two  papers :  (i)  On 
injuries  to  peripheral  nerves.  (2)  On  the  rational  treat- 
ment of  goitre.  In  professional  politics,  his  chief  engage- 
ments were  on  June  15,  when  he  spoke  at  a  meeting  of 
medical  men  in  Stratford,  and  defended  Mr.  Balfour's  Bill 
for  the  Registration  of  Midwives  ;  and  on  November  22, 
when  he  spoke  at  a  meeting  of  160  medical  men  in  Newcastle, 
called  to  hear  him  and  the  other  two  direct  representatives 
on  the  General  Medical  Council. 


1900-1901 

In  1900,  at  last,  he  had  wards  of  his  own  in  University 
College  Hospital.  One  of  his  old  House-surgeons,  Dr. 
Wirgmans,  writes  : 

My  first  intimate  association  with  him  was  in  1900,  when 
my  fatlicr  broke  his  thigh,  and  I  asked  Horsley  to  see  the 
case  in  consultation.  Although  there  was  no  reason  at  all 
why  a  fee  should  not  have  been  accepted,  it  was  refused, 
I  will  not  say  with  scorn,  but  as  quite  an  unheard-of  idea  ! 
I  was  fortunate  enough  to  be  his  House-surgeon  for  six 
months  in  1901-02.  I  well  remember  my  first  day  with  him 
in  the  theatre.  He  was  a  firm  believer  in  the  constant  irri- 
gation of  the  operation  area  with  hot  perchloride  solution ; 
and  hot  the  solution  had  to  be.  It  never  quite  boiled,  but 
to  the  H.S.  who  had   to  keep  it   dripping,  the  difference 


FROM  1899  TO  1906  169 

was  inappreciable  !  At  the  end  of  the  day  I  was  more 
or  less  soaked.  I  crept  home  with  an  umbrella  pressed 
to  my  legs,  trying  to  conceal  as  much  bloodstain  as  pos- 
sible. Another  noticeable  thing  in  his  work  was  the  vast 
quantity  of  gauze  used  in  the  dressing  of  head-cases,  I 
should  not  describe  him  as  a  great  teacher  or  lecturer,  but 
his  example  was  worth  much,  particularly  to  those  who  were 
lucky  enough  to  be  brought  into  close  contact  with  him. 
He  had  a  pecuhar  gift  of  inspiring  one  witii  confidence  in 
oneself,  and  trusted  his  House-surgeon  very  greatly,  which 
naturally  calls  out  the  best  service  from  a  man.  There  was 
nothing  more  irritating,  or  amusing — I  hardly  know  which 
word  to  use — than  the  way  in  which  his  anti-vivisectionist 
opponents  described  him  as  a  cruel  man.  I  never  knew  one 
who  was  more  careful  to  lessen  suffering,  and  to  avoid  causing 
pain.  His  dressers  were  soon  taught  that  the  dressings  had 
to  be  soaked  till  they  came  away  of  themselves  ;  or  they 
got  a  sharp  telling-off.  To  his  patients  he  was  kindness 
itself ;  and  for  those  who  went  to  him  for  advice  there  was 
always  full  and  careful  help  in  every  way  possible. 

One  of  his  colleagues  remembers  of  him  that  he  was  fond 
of  giving  to  his  ward-teaching  the  appearance  of  a  consulta- 
tion, in  which  this  or  that  student  would  be  expected  to 
reason  out  the  points  of  a  case  with  him.  Another  writes 
of  the  devotion  which  he  gained  from  his  House-surgeons 
and  his  students  by  '  his  easy  simplicity,  his  charming  sense 
of  fun,  his  assumption  of  complete  equality.'  He  had 
neither  time  nor  inclination  for  teaching  the  commonplaces 
of  general  surgery  ;  and  he  usually  transferred  to  his  assistant- 
surgeon  cases  which  offered  to  himself  no  opportunity  of 
teaching  or  of  learning.  But,  '  little  as  he  did  of  formal 
teaching,  his  influence  upon  the  whole  surgical  tone  of  his 
school  was  profound.' 

At  Queen  Square,  in  1900,  faults  of  administration,  which 
had  been  going  on  for  many  years,  reached  their  height. 
The  Hospital  Sunday  Fund  withheld  a  grant  to  the  Hospital, 
till  things  should  be  better  managed  :  a  Committee  of 
Enquiry  was  appointed,  under  Sir  Edward  Fry,  and  the 
unhappy  dispute  was  j)roclaimed  far  and  wide  in  the  news- 
])apers.  The  Staff  were  not  to  blame  for  these  troubles  : 
there  never  was  a  Staff  more  loyal  in  the  service  of  their 
Hospital.     They  had   two  very  serious  grievances  :     they 


170  SIR  VICTOR  HORSLEY 

were  not  properly  represented  on  the  Board  of  Management, 
and  they  were  subjected  to  a  sort  of  nagging  espionage  ;  as 
if  they  were  the  servants  not  of  the  Hospital,  but  of  the 
Board  of  Management.^  WTien  one  thinks  who  they  were, 
the  notion  of  any  body  of  non-medical  men  behaving  un- 
generously toward  them  is  comical :  but  the  harm  done  to 
the  Hospital  was  beginning  to  be  tragical.  In  these  years 
of  conflict,  Horsley  did  his  share  of  the  fighting,  but  not  more 
than  his  share.  The  final  manifesto  of  the  Staff  against  the 
Board  of  Management  is  dated  August  4,  1900.  With  the 
appointment  of  Mr.  Dan  vers  Power  as  Chairman,  every- 
thing was  gradually  changed  :  he  was  the  saving  of  the 
Hospital. 

In  1900,  Horsley  published  a  clinical  lecture  on  compres- 
sion-paraplegia :  an  address  at  a  conference,  in  Manchester,  on 
'  Medical  Organisation  '  :  and  his  Lees  and  Raper  Memorial 
Lecture  on  the  effect  of  alcohol  on  the  human  brain.  In 
1901,  he  published,  with  Dr.  Thiele, '  A  study  of  the  degenera- 
tions observed  in  the  central  nervous  system  in  a  case  of 
fracture-dislocation  of  the  spine.' 


1902-1903 

In  1902,  he  received  the  honour  of  knighthood  ;  to  his 
great  astonishment  :  for  the  letter  offering  it  was  the  first 
intimation  of  any  kind  which  he  had  of  it,  nor  did  he  even 
know  who  had  recommended  him.     He  and  Beevor,  this 

'  There  was  another  condition  of  Horsley's  work,  which  vexed  him 
again  and  again.  He  never  had  beds  of  his  own  :  all  cases  must  be  admitted 
under  the  physicians  :  he  could  not  take  charge  of  any  patient  except  at 
the  request  of  one  of  the  physicians.  Even  those  patients  who  were 
sent  to  the  Hospital  for  the  express  purpose  of  being  under  his  care  must 
be  admitted  as  '  medical  cases.'  He  never  got  away  from  this  rule.  The 
physicians  mostly  did  their  best  to  make  it  easy  for  him.  Sir  VVilUam 
Gowers,  for  example,  writes  to  him  about  a  patient,  in  July,  1896:  '  A 
case  I  admit  for  you  I  regard  as  being  only  nominally  under  my  care,  and 
I  have  been  waiting  for  an  expression  of  your  desire  that  I  should  look 
into  this  case.  .  .  .  You  know  I  entertain  the  strongest  opinion  on  the 
injustice  of  the  arrangement  by  which  you  have  no  beds  of  your  own.' 
The  rule  ought  to  have  been  modified  or  revoked.  It  was  absurd,  that  a 
patient  should  travel  a  hundred  miles  or  more  to  be  under  Horsley,  and 
then  should  be  under  somebody  else.  Besides,  mistakes  or  misunder- 
standings were  apt  to  happen,  and  to  be  sharply  resented  not  only  by 
him  but  by  the  patient's  friends,  or  by  the  medical  man  who  had  sent 
the  patient  to  the  Hospital. 


FROM  1899  TO  1906  171 

year,  published  in  Brain  a  minute  account  of  the  nerve-fibres 
passing  from  the  cerebral  cortex  to  the  corpora  quadrigemina 
and  the  optic  thalami.  In  their  earher  work,  not  having 
the  use  of  Marchi's  method,  they  had  failed  to  trace  these 
fibres.^  In  October,  he  gave  the  introductory  address  of  the 
winter  session  at  University  College,  Bristol.  He  also  read 
a  paper,  at  the  Bolingbroke  Hospital,  on  the  radical  cure  of 
hernia  :  and  Risien  Russell  and  he  opened  a  discussion,  at 
the  Medical  Society  of  London,  on  the  medical  and  surgical 
treatment  of  epilepsy. 

In  February,  1903,  at  a  meeting  of  the  Leicester  Medical 
Society,  he  spoke  '  On  the  consolidation  of  the  public  and 
professional  interests  of  medical  men.'  He  referred  to  the 
great  increase  in  the  number  of  medico-ethical  societies,  and 
to  the  reconstruction  of  the  British  Medical  Association  on 
stronger  and  wider  lines  :  ^  and  he  attacked  the  Council  of 
the  College  of  Surgeons  for  not  doing  more  for  the  profession  : 

Though  in  the  Middle  Ages  the  Corporate  Guilds  may  have 
exercised  considerable  influence,  the  College  of  Surgeons  only 
increased  its  membership  with  the  development  of  the  pro- 


*  An  admirable  account  of  Marchi's  method  was  given  to  the  second 
RoyaJ  Commission  on  experiments  on  animals,  November  27,  1907,  by 
Dr.  Head.  '  The  beginning  of  our  present  knowledge  came  with  Waller's 
discovery  that  a  nerve  degenerated  when  separated  from  its  nutritive 
centre.  This  law  was  the  direct  outcome  of  experiments  on  animals, 
and  its  application  to  the  brain  and  spinal  cord  has  been  responsible  for 
the  greater  part  of  that  knowledge  we  now  possess  of  the  structure  of  the 
nervous  system.  When  a  nerve  is  separated  from  its  nutritive  centre, 
it  becomes  gradually  funclionless  ;  but  also  it  becomes  gradually  destroyed 
entirely,  so  that  no  nervous  matter  is  left  behind.  .  .  .  Imagine  a  wall 
covered  with  creepers  arising  from  several  stems.  If  we  wished  to  know 
from  which  of  these  any  one  branch  takes  its  origin,  wc  could  cut  one  stem, 
and  every  branch  arising  from  it  would  die,  marking  out  among  the  healthy 
foliage  the  offshoots  of  the  divided  stem.  This  is  the  principle  that  has 
been  used  in  tracing  the  paths  in  the  nervous  system.  .  .  .  By  experiments 
on  animals,  a  tract  or  .set  of  tracts  can  bo  divided  precisely  ;  tlic  animal 
is  kept  alive  until  degeneration  has  taken  place,  and  is  then  killed.  By 
suitable  means  the  deatl  parts  can  bo  coloure<l  .so  as  to  stanil  out  clearly 
in  the  microscopical  picture.  The  method  by  which  these  dead  structures 
are  made  to  show  up  clearly  against  the  liealtliy  parts  was  discovered  by 
Marchi  from  experiments  on  animals.  Waller's  law  and  Marchi's  method, 
applied  to  material  obtained  from  experiments  on  animals  and  from  disease 
or  injury  in  man,  are  responsible  for  almost  all  our  knowledge  of  the 
anatomical  paths  in  the  nervous  system.' 

•  The  medico-ethical  societies  worked  apart,  each  in  its  own  ilistrict. 
There  was  talk  of  making  a  federation  of  them  :  but  this  plan  was  set 
aside  by  the  reconstruction  of  the  British  Medical  Association, 


T72  SIR  VICTOR  HORSLEY 

fession,  and,  like  all  other  medical  corporate  bodies,  it  has 
become  more  interested  in  preserving  its  existence  than  justi- 
fying it.  The  members  of  its  Council,  who,  though  but 
twenty-four  in  number,  have  arrogated  to  themselves  the 
rights  and  privileges  of  their  20,000  colleagues  who  com- 
pose the  College,  do  httle  more  than  carry  on  the  adminis- 
tration of  the  conjoint  examinations,  and  maintain  the 
buildings  and  museum  of  the  College.  They  have  never 
publicly  moved  in  support  of  the  interests  of  the  profession 
as  a  whole.  Neither  will  they  move.  In  fact  it  is  prac- 
tically certain  that  the  attitude  of  the  Council  of  the  College 
of  Surgeons  will  be  to  oppose  the  Medical  Acts  Amendment 
Bill  which  we  require,  because  they  believe  that  a  real  refonn 
will  threaten  their  income. 

Surely  he  overstates  his  case  here  ;  and  again,  in  the 
address  which  he  gave  in  October,  at  the  opening  of  the 
Birmingham  winter  session,  on  '  The  purposes  and  main- 
tenance of  our  Universities,'  when  he  spoke  of  '  the  sterile 
training  in  dead  languages  and  somewhat  moribund  systems 
of  philosophy  unfortunately  characteristic  of  an  old  Uni- 
versity like  Oxford,'  and  dismissed  Sir  William  Anson's  views 
on  education  as  if  they  were  hardly  worth  considering.  But 
he  spoke  with  good  judgment  of  the  maintenance  of  our 
Universities  ;  and  made  a  line  appeal  for  State  aid  for 
them. 

At  the  meeting  in  Swansea  of  the  British  Medical  Associa- 
tion, he  was  Chairman  of  the  Meeting  of  Representatives. 


1904  {£bL  47) 

At  Queen  Square,  in  1904,  the  Nervous  Diseases  Research 
Fund  was  instituted,  for  the  microscopical,  chemical,  and 
bacteriological  study  of  these  diseases.  Some  months  later, 
he  received  a  gift  of  /^looo  for  any  charitable  purpose  ;  and 
had  the  pleasure  of  using  it  for  this  Fund.  Mr.  Danvers 
Power  writes  : 

I  saw  a  good  deal  of  him,  when  I  was  Chairman  of  the 
Hospital  under  its  new  constitution,  after  the  dispute  between 
the  Staff  and  the  Board,  in  which  he  was  really  the  leading 
spirit.  From  first  to  last  I  found  him  the  exact  opposite 
of   what   I   had  expected  from  liis  controversial  writings. 


FROM  1899  TO  1906  173 

Having  had  the  good  fortune  to  be  the  humble  instrument 
of  providing  him  with  a  proper  operating-theatre  at  the 
Hospital,  and  also  of  setting  on  foot  a  little  research  fund, 
I  can  truly  say  that — whatever  it  may  have  been  to  opponents 
— his  ordinary  manner  to  those  who  showed  any  kind  of  prac- 
tical sympathy  with  liis  work  was,  as  far  as  my  experience 
went,  very  gentle  and  most  attractive.  He  never  forgot 
to  back  support  from  laymen  by  his  own  exertions,  and 
always  showed  warm  gratitude  for  it.  I  never  knew  him 
make  an  unreasonable  request. 

As  you  know,  he  had  extreme  views  on  some  subjects, 
and  they  occasionally  brought  him  public  rebuffs.  I  re- 
member his  once  saying  to  me,  when  he  was  suffering  from 
one  of  these,  '  What  they  don't  see  is  that  my  object  is  the 
health  of  the  country.'     I  wish  every  one  could  say  as  much. 

In  ]\Iarch,  he  gave  evidence  before  the  Committee  on 
Physical  Deterioration.  He  so  feared  and  hated  this 
national  evil,  that  he  must  have  longed  to  speak  of  every 
aspect  of  it ;  but  he  was  limited  to  one  subject,  the  venereal 
diseases,  their  effect  on  the  national  health,  and  the  measures 
to  be  taken  against  them.  The  first  thing  to  be  done,  he 
said,  was  to  appoint  a  Commission  to  enquire  into  their 
prevalence.  Statistics  founded  on  Hospital  practice  were 
useless.     So  were  statistics  founded  on  death-certificates  : 

At  the  present  moment,  when  a  medical  man  gives  a 
certificate  of  the  cause  of  death,  he  is  writing  a  document 
which  is  for  the  information  of  the  family,  but  it  is  a  docu- 
ment which  is  indirectly  to  be  the  scientific  basis  of  statistics 
for  the  nation.  These  two  things  are  really  quite  apart  : 
you  cannot  combine  them.  Therefore  it  comes  to  this,  tiiat 
any  document  certifying  the  cause  of  death  ought  to  be  a 
scientific  document,  a  (iovemmcnt  document,  wliat  we  may 
call  a  State  j)apLr  and  a  piivilcgt^d  i)aper,  to  be  given  to  the 
Government  ofhcial,  the  Registrar-General  :  and  the  con- 
tents of  that  document  should  only  be  communicated  to 
the  friends  or  relatives  of  the  patient  at  the  Registrar-General's 
discretion. 

He  was  in  fuvi'ur  ol  compulsory  notification  :  but  li<-  saw 
the  dilhcultics  in  the  way  of  it.  He  was  asked  whether  lie 
thought  that  any  serious  penalty  ougiit  to  be  imposed  on  a 
man  who  knowingly  caused  infection  ;   and  he  answered  : 

I  think  that,  as  the  ordinary  outcome  of  a  Notification 
Act,  it  w(;uld  be  possible  to  have  a  statutory  penalty  on 


174  SIR  VICTOR  HORSLEY 

persons  of  both  sexes.  I  do  not  think  it  ought  to  be  Umited 
only  to  the  male  sex,  but  I  think  certainly  there  ought  to 
be  a  penalty,  so  soon  as  the  thing  is  put  upon  the  ordinary 
basis  of  an  infectious  disease. 

The  Committee,  in  their  Report,  July  1904,  recommended 
that  a  death-certificate  '  should  be  regarded  as  confidential, 
and  its  contents  should  never  be  divulged  by  the  Registrar, 
as  is  permissible  at  present,  to  the  friends  of  the  deceased. 
It  should  be  sent  by  the  local  Registrar  direct  to  the  Regis- 
trar General.'  They  also  recommended  the  appointment  of 
a  Commission  of  Enquiry  into  the  prevalence  and  effects  of 
syphilis,  having  special  regard  to  the  question  of  the  possi- 
bility of  making  the  disease  notifiable,  and  to  the  adequacy 
of  Hospital  accommodation  for  its  treatment. 

At  the  Oxford  meeting  of  the  British  Medical  Association, 
he  opened  a  discussion  on  chloroform-anaesthesia.  This 
discussion  was  the  chief  event  of  the  meeting.  It  was  three 
years  since  the  Association,  by  Dr.  Waller's  advice,  had 
appointed  a  Committee  to  study  chloroform  through  and 
through.  Waller,  Sherrington,  Vernon  Harcourt,  Dudley 
Buxton,  Horsley,  and  others  had  been  working  at  it  from 
all  points  of  view  ;  in  physics  and  chemistry  and  pathology 
and  physiology  and  practice.  They  had  just  issued  their 
third  report ;  they  had  corrected  or  re-stated  the  results 
obtained  by  the  Hyderabad  Commission.  Chloroform  is 
one  of  those  drugs  which  will  never  let  the  last  word  be  said 
about  them. 

They  had  proved  that  rather  less  than  two  per  cent,  of 
chloroform-vapour  in  air  is  sufficient  to  induce  anaesthesia, 
and  that  much  less  than  two  per  cent,  is  sufficient  to  maintain 
it  during  an  operation.  The  question  was,  Ought  the 
anaesthetist  to  use  a  special  apparatus  exactly  registering  the 
percentage  of  vapour,  and  enabhng  him  exactly  to  control 
and  adjust  it  during  the  operation  ?  Or  ought  he  to  use 
the  simplest  of  all  methods,  sprinkling  the  drug  on  a  fold  of 
lint,  relying  on  his  own  experience  and  watchfulness,  without 
having  to  attend  to  any  sort  of  apparatus  ?  The  debate  at 
Oxford  was  followed  by  debates  at  the  Society  of  Anaesthet- 
ists and  at  the  Royal  Medical  and  Chirurgical  Society.     Mr. 


FROM  1899  TO  1906  175 

Vernon  Harcourt,  and  Dr.  Alfred  Levy,  had  invented  two 
forms  of  apparatus  ;  with  either  of  them  the  anaesthetist 
could  exactly  tell  what  dose  he  was  giving  at  any  moment  : 
but  the  art  of  giving  anaesthetics  is  so  '  personal,'  so  closely 
dependent  on  the  individuality  of  the  anaesthetist,  that 
opinions  were  divided,  w'hether  science  could  rightly  dictate 
to  practice.  Horsley  was  quite  sure  that  the  percentage 
ought  to  be  exactly  controlled.  He  always  liked  to  have 
the  Vemon-Harcourt  inhaler  used  for  his  operations.  He 
especially  valued  it  in  cases  of  brain-surgery  with  increase  of 
intra-cranial  pressure  :  this  pressure  might  of  itself  cause 
sudden  death,  or  might  make  fatal  a  percentage  which 
otherwise  would  be  absolutely  safe.  But  he  also  used  the 
inhaler  in  operations  of  general  surgery. 

He  gave  an  address,  this  year,  to  the  Wimbledon  Medical 
Society,  '  On  tactile  sensation.'  It  is  concerned  with  the 
question.  How  is  the  study  of  tactile  sensation  useful  as  a 
guide  for  the  localising  of  a  disease  or  injury  of  the  brain  ? 
He  begins  with  an  account  of  the  work  done  on  this  subject 
by  Head  and  Mott ;  he  agrees  with  them,  that  the  sensory 
channels  terminate  in  the  centres  of  the  optic  thalamus,  and 
that  new  channels  start  from  the  optic  thalamus  to  the 
cortex  : 

Under  these  circumstances,  we  naturally  expect  that  the 
representation  of  sensation  in  the  cortex  must  be  something 
very  special  ;  and  I  venture  to  submit  to  you  that  it  is, 
and  that  by  a  determination  of  this  character  we  can  form 
an  exact  diagnosis  of  the  lesion,  as  to  whether  it  is  in  the 
cortex  cerebri  or  in  the  region  below  the  optic  thalamus. 

He  points  out  that  the  motor  area  of  the  cortex  does 
receive  sensory  hbres  ;  and  so  he  comes  to  the  question, 
What  special  sort  of  insensitiveness  is  evidence  of  injury  or 
disease  involving  the  cortex  ?  And  he  answers,  that  the 
cortex  enables  us  not  only  to  be  conscious  of  a  touch,  but  to 
identify  the  point  touched  : 

I  have  urged  again  and  again,  and  perhaps  it  may  be 
known  to  some — but  I  would  like  to  repeat  it — that  m  our 
clinical  investigation  of  cases  of  anaesthesia  it  is  not  suffi- 
cient for  us  simply  to  touch  a  patient  and  say  '  Do  you  feel 


176  SIR  VICTOR  HORSLEY 

that  ?  '  and  so  on,  because  if  he  has  any  tactile  sensation 
at  all  he  will  say  '  Yes  '  quite  correctly  ;  but  the  part  to 
be  tested  should  be  screened  from  the  patient  (it  is  much 
better  than  blindfolding  him)  and  the  part  should  be  touched 
very  lightly,  and  he  should  then  be  compelled  to  mark  with 
his  own  index-finger  the  part  which  you  have  touched. 
If  you  do  that,  you  may  discover,  often  to  your  surprise, 
that  he  has  entirely  lost  his  knowledge  of  the  exact  spot 
which  was  irritated.  Under  these  circumstances  you  are 
at  once  furnished  with  a  differential  diagnosis  :  you  know 
perfectly  well  that  the  lesion  cannot  be  anywhere  below  the 
optic  thalamus,  and  you  know  it  must  be  somewhere  in  the 
region  of  the  cortex. 

At  the  Oxford  meeting,  he  had  invited  Dr.  MacNalty,  who 

was  working  with  Dr.  Gustav  Mann  on  the  structure  of  the 

optic  thalamus,  to  come  and  work  in  London.     From  1904 

to  1909,  Dr.  MacNalty  assisted  him  in  his  researches  at 

University  College  and  at  home  ;  and  writes  of  these  years  : 

He  began  his  day  at  7  a.m.,  breakfasted  at  7.30,  often 
earher,  and  was  usually  operating  soon  after  8.  From  then, 
work  went  on  almost  uninterruptedly  until  11  p.m.  When  I 
first  knew  him  (1904)  he  was  surgeon  both  to  University 
College  Hospital  and  to  Queen  Square  ;  he  had  a  large 
private  practice ;  he  was  on  the  General  Medical  Council,  and 
busy  with  affairs  of  the  British  Medical  Association  ;  and  he 
was  daily  engaged  in  cerebral  research,  either  in  his  private 
laboratory  behind  the  anatomical  theatre  of  University 
College,  or  at  his  own  house. ^    He  was  constantly  in  demand, 

'  Of  course,  he  was  forbidden,  by  the  Act,  to  make  experiments  on 
animals  at  his  own  house  :  they  must  be  made  only  in  places  registered 
under  the  Act.  Once,  in  1893,  he  had  leave  to  make  two  inoculation- 
experiments  at  a  private  house  ;  but  he  did  not,  after  all,  make  them. 
See  his  evidence  before  the  second  Royal  Commission  :  '  These  experiments 
were  the  inoculation  of  blood  from  a  patient  suffering  from  filaria  sanguinis 
hommis.  This  is  a  peculiar  worm  which  discharges  its  embryos  into  the 
blood  of  a  patient  at  night-time.  The  embryos  do  not  come  into  the  blood 
till  about  ten  o'clock  at  night,  and  they  flourish  in  the  blood  when  the 
patient  is  lying  half  unconscious  or  unconscious  in  sleep  ;  and  when  he 
wakes  in  the  morning,  anrl  begins  to  move  about,  these  embryos  disappear 
again  :  hence,  the  only  time  you  can  get  the  living  embryos  is  in  the 
night,  so  that  it  is  necessary  to  ilo  this  inoculation  in  the  niglit-timc.  All 
the  laboratories  are  closed  at  night  ;  and  Sir  Patrick  Manson,  for  whom  I 
was  going  to  do  the  inoculation,  brought  the  patient  to  a  private  house  for 
me  to  do  it.  As  a  matter  of  fact,  wc  examined  the  patient's  lilood,  and 
we  found  that  he  had  no  embryos  in  his  blood,  or  hardly  any  ;  the  reason 
bemg,  tliat  lie  had  injured  the  lymph-glands  in  which  the  parent  worm 
was  living  :  which  had  caused  inflammation  and  ha<l  caused  the  death  of 
the  parent  worm.  And  there  was  an  end  of  the  experiment :  and  there 
was  an  end  of  the  whole  matter,  because  I  have  never  done  any  experi- 
ment in  any  unregistered  place  at  any  time  in  my  life  before  or  since.* 
(Minutes  of  Evidence,  vol.  iv.  p.  128,  November  13,  1907.) 


FROM  1899  TO  1906  177 

also,  for  political  addresses,  lectures  at  medical  societies, 
etc.  He  never  neglected  any  detail  of  his  work.  I  have 
often  been  working  with  him  in  the  evening,  when  he  has 
looked  at  his  watch,  pushed  a  tray  of  sections  over  to  me, 
and  announced  that  he  had  some  cases  to  dress.  I  think  he 
often  strained  his  amazing  powers  to  the  utmost.  Some- 
times, after  a  long  day,  a  very  weary  look  would  come  over 
his  face,  and  he  would  say  that  he  must  sleep  for  a  little 
while  ;  and  he  would  fall  asleep  for  five  or  ten  minutes  and 
then  wake  up  refreshed  and  ready  to  continue  work. 

Neurologists  from  all  over  the  world  would  attend  to 
watch  him  at  his  experimental  work,  and  any  keen  resident 
at  U.C.H.  or  Queen  Square  was  certain  of  an  invita- 
tion to  the  laboratory.  As  far  as  possible,  he  set  aside 
Thursday  afternoons  and  Saturday  mornings  for  experi- 
mental work.  The  same  scrupulous  precautions  were 
observed  in  experiments  as  in  a  surgical  operation.  He 
always  dressed  and  bandaged  the  wounds  himself,  and 
looked  very  carefully  after  the  well-being  of  the  animals. 
He  was  very  fond  of  animals,  and  would  caress  and  play  with 
the  monkeys  and  feed  them  with  bananas.  Apart  from 
his  stated  hours,  he  would  appear  in  the  laboratory  at  odd 
moments,  often  in  the  early  morning,  and  cut  sections  for 
about  half  an  hour.  I  think  the  mere  mechanical  work  of 
using  the  microtome  rested  him.  At  such  times  he  would 
talk  to  one  on  all  sorts  of  subjects  and  at  intervals  would 
whistle  tunes  out  of  the  Gilbert  and  SulHvan  operas. 

He  only  gave  up  his  private  laboratory  within  a  year  or 
two  of  the  outbreak  of  the  War.  His  amount  of  scientific 
output  in  those  precious  hours  snatched  from  other  work 
would  have  amply  sufficed  for  the  whole  time  of  many  a 
professor  of  physiology.  He  had  the  gift  of  mental  concen- 
tration in  no  small  degree.  Like  Arnold  of  Rugby,  he  could 
work  with  liis  family  round  him. 


1905 

This  year,  R.  H.  Clarke  and  Horsley  published  their  paper 
'  On  the  intrinsic  fibres  of  the  cerebellum,  its  nuclei,  and  its 
efferent  tracts.'  They  had  set  themselves  to  answer  the 
questions,  How  is  the  cortex  of  the  cerebellum  linked  up 
from  point  to  point  of  its  surface  ?  How  is  it  linked  up  to 
the  underlying  cerebellar  nuclei  ?  Is  there  a  direct  efferent 
tract  from  the  cerebellum  to  the  spinal  cord  ?  (That  is 
to  say,   Do   the  peduncles,    the   great    bundles  of   nerve- 

M 


178  SIR  VICTOR  HORSLEY 

fibres  between  the  brain  and  the  cord,  contain  any  fibres 
coming  direct  from  the  cerebellum  ?)  If  such  a  tract  does 
exist,  is  it  derived  from  the  cerebellar  cortex  ?  Or  is  it 
derived  from  the  cerebellar  nuclei  ?  And,  if  so,  from  which 
nuclei  ? 

They  made  altogether  twenty-three  experiments,  using 
Marchi's  method.  In  their  paper,  they  review  the  work  of 
other  writers  on  the  subject,  from  1891  to  1905  ;  and  are  in 
agreement  with  Ferrier,  Aldren  Turner,  and  Risien  Russell. 
They  give  an  elaborate  description  of  the  naked-eye  anatomy 
of  the  cerebellum,  its  divisions  and  subdivisions  :  here  they 
mostly  adopt  the  nomenclature  devised  by  Elliot  Smith. 
Finally,  they  point  out  that  the  temporal  region  of  the 
cortex  cerebri  is  closely  associated  with  the  cerebellum  ;  it 
is  concerned  with  the  sense  of  hearing  ;  it  may  therefore  be 
concerned  with  that  sense  of  equilibrium  which  is  controlled 
by  a  portion  of  the  auditory  nerve  ;  and  here  may  be  a  clue 
to  the  disturbances  of  equiUbrium  which  attend  injury  or 
disease  of  the  cerebellum. 

They  sum  up  the  microscopic  structure  of  the  cerebellum 
as  follows  : 

All  the  specimens  show  abundant  arcuate  fibres  con- 
necting various  parts  of  the  cortex,  and  other  fibres  passing 
to  the  nearest  cerebellar  nuclei ;  but  none  going  directly 
from  the  cortex  cerebelli  to  any  of  the  peduncles.  Our 
series  of  sections  also  show  that  all  efferent  cerebellar  cortical 
fibres,  in  the  first  instance,  pass  to  one  or  other  of  the  central 
nuclei,  and  principally  to  the  one  which  is  nearest  to  their 
origin. 

Another  paper  in  Brain  this  year,  by  Horsley,  is  of  a  very 
different  kind,  on  a  chance  observation  made  in  the  course 
of  his  work  :  he  had  found  a  '  trigeminal-aural  reflex  in  the 
rabbit,'  i.e.  a  reflex  movement  of  the  rabbit's  ear,  following 
stimulation  of  the  trigeminal  nerve.  The  setting  up  of  the 
ears,  as  he  says,  '  has  always  been  regarded  as  voluntary — a 
high  purposive  act  on  the  part  of  the  animal  to  detect  a 
source  of  danger.'  But  he  found  that  if  he  gently  touched 
the  skin  or  the  long  hairs,  in  the  infra-orbital  region,  which 
is  supplied  by  the  trigeminal  nerve,  the  ear  on  that  side 


FROM  1899  TO  1906  179 

was  raised  and  carried  forward  :   it  remained  thus  for  some 
seconds,  and  then  slowly  dropped  : 

Pricking  of  the  ears  being  undoubtedly  associated  with 
an  appreciation  of  danger,  it  is  reasonable  that  it  should 
occur  when  the  infra-orbital  region,  and  especially  the 
vibrissae,  are  touched ;  since  a  rabbit  in  escaping  from 
danger  encounters  numerous  obstacles  as  it  runs  in  the 
depths  of  the  burrow,  or  through  bushes  and  grass  in  the 
dark,  and  therefore  must  largely  rely  on  contact-impressions 
from  its  face. 

From  this  chance  observation  in  natural  history,  which 
would  have  delighted  Mr.  Darwin,  he  goes  on  to  speak  of  his 
experiments — especially  those  which  he  had  made  in  1904 
with  Magnus  of  Christiania — on  the  representation,  in  the 
corpora  quadrigemina,  of  this  listening-movement  of  the 
ears  ;  a  movement  altogether  different  from  the  setting 
back  of  the  ears,  for  protection  in  fighting,  which  '  can  be 
obtained  from  a  wide  area  of  the  cortex  cerebri  in  all 
animals,  notably  the  ungulata.'  The  representation,  in 
the  corpora  quadrigemina,  of  the  listening-movement,  was 
first  observed  by  Ferrier,  long  before  1904 :  Horsley  now 
couples  it  with  the  fact  that  the  sense  of  hearing,  hkewise,  is 
represented  there. 

In  1905,  also,  he  gave  the  Boyle  Lecture,  in  Oxford,  to  the 
Junior  Scientific  Society  of  the  University  :  '  The  Cerebellum, 
its  relation  to  spatial  orientation  and  to  locomotion.' 


1906 

This  year  seems  to  mark  the  end  of  a  period  ;  not  only  by 
the  work  which  he  did,  but  by  the  work  which  he  resigned. 
It  was  the  fiftieth  year  of  his  Hfe.  He  gave  up  his  appoint- 
ment at  University  College  Hospital,  and  his  Profcssoi-ship 
of  Surgery  at  University  College.  His  second  term  of  oflice 
on  the  General  Medical  Council  came  to  an  end  ;  and  he 
did  not  seek  re-election.  He  completed  twenty  years  at 
Queen  Square  ;  and,  in  his  Toronto  address  on  brain- 
surgery,  he  summed  up  what  h<'  had  learned  in  all  tiiat 
time. 


i8o  SIR  VICTOR  HORSLEY 

It  has  been  said  of  him,  that  he  would  have  done  far  more 
for  science,  if  only  he  had  kept  clear  of  politics.  There  is 
very  httle  truth  in  that  saying.  His  chief  discoveries  in 
physiology  and  in  surgery  were  made  early,  in  the  wonderful 
years  between  1884  and  1900,  when  politics  had  not  much 
hold  on  him.  Besides,  the  output  of  his  work  for  science, 
now  more  now  less,  never  stopped  :  it  went  on  right  up  to 
the  time  of  the  War. 

He  certainly  did  enough,  in  1906,  both  for  science  and  for 
practice,  to  satisfy  the  greediest  of  his  critics. 

In  February,  in  Sheffield,  he  gave  an  address,  '  On  the 
diagnosis  and  surgical  treatment  of  diseases  of  the  pituitary 
gland.'  It  wiis  thirty  years  since  he  had  made,  at  the  Brown 
Institution,  the  first  experiments  ever  made  on  the  removal 
of  the  gland.  By  1906,  he  had  operated  on  nine  patients,  of 
whom  two  had  died :  but  in  neither  case  was  the  opera- 
tion the  only  cause  of  death.  The  whole  subject  is  too 
new,  and  too  abstruse,  to  be  considered  here  :  it  is 
very  fully  considered  in  Harvey  Cushing's  classical  book. 
The  Pituitary  Body  and  its  Disorders  (Lippincott,  Philadel- 
phia, 1912). 

He  gave  the  Hughlings  Jackson  Lecture,  this  year,  to  the 
Neurological  Society, '  On  the  physiological  relations  between 
the  cerebrum,  the  cerebellum,  and  the  spinal  cord.*  It  was 
the  fiftieth  year  of  Hughlings  Jackson's  practice  :  a  good 
occasion  to  thank  and  praise  him  : 

His  teaching  of  first  principles  will  always  be  gratefully 
remembered  by  the  ever-increasing  army  of  neurologists  ; 
but  this  is  the  opportunity  for  those  of  us  who  have  enjoyed 
the  inestimable  privilege  of  being  immediately  his  pupils, 
specifically  to  recall  the  profound  deptli  of  our  indebted- 
ness to  him.  .  .  . 

The  greatest  principle,  whicli  underlies  all  he  has  written, 
is  the  true  nature  of  localisation  of  function  in  the  central 
nervous  system  :  namely,  that  it  is  relative  and  not  abso- 
lute ;  that  conceivably  every  part  of  the  body  is  repre- 
sented in  every  nerve-centre,  just  as  it  of  necessity  is  in  the 
single  primordial  ovum  :  and  that  when  the  nervous  system, 
considered  functionally,  is  regarded,  in  the  view  of  Flourens, 
as  working  as  a  whole,  the  determination  of  action  by  any 
given  part  is  never  more  than  relative.  .  .  .  When  we  are 


FROM  1899  TO  1906  181 

labouring  with  the  difficulties  of  endeavouring  to  establish 
a  differential  diagnosis,  we  are  Ukely  to  forget  that  the  whole 
machine  is  in  active  operation  while  our  attention  may  be 
drawn  to  one  point  only. 

He  published  three  papers,  this  year,  in  Brain  :  (i)  On 
the  taenia  pontis.  (2)  On  the  orientation  of  points  in  space. 
(3)  On  apparent  re-representation,  in  the  cerebral  cortex, 
of  the  type  of  sensory  representation  as  it  exists  in  the  spinal 
cord. 

1.  The  taenia  pontis  is  a  small  tract  of  nerve-fibres  along 
the  anterior  border  of  the  pons  Varolii.  It  is  seldom  sym- 
metrical :  and  it  may  be  either  superficial,  or  embedded  in 
the  pons.  The  lower  the  type  of  brain,  the  more  probability 
that  the  taenia  will  be  superficial.  He  studied  it  in  three 
types  of  brain — the  hippopotamus,  the  camel,  and  man. 
Up  to  1906,  it  had  been  regarded  as  a  tract  of  efferent  fibres, 
passing  from  the  cerebellum  to  the  pons.  By  a  single  ex- 
periment (Marchi's  method)  he  proved  that  the  fibres  are 
afferent ;  that  they  pass  from  nuclei  in  the  pons  to  nuclei  in 
the  cerebellum. 

2.  The  orientation  of  points  in  space  was  worked  out  with 
the  help  of  Dr.  Townley  Shngcr.  The  observations  were 
made  some  in  London,  some  in  Cambridge  with  the  help  of 
Dr.  Rivers,  and  some  at  the  South  Norwood  College  for  the 
Blind.  Horsley  had  devised  a  glass  plate  ruled  in  squares 
of  half  a  centimetre  ;  it  could  be  set  at  any  plane,  and 
screened  from  sight.  The  person  tested  had  to  keep  a 
fmger  of  one  hand  on  the  under  surface  of  the  plate,  and  to 
try  to  touch  with  a  finger  of  the  other  hand  the  correspond- 
ing point  on  the  upper  surface  of  the  plate.  This  and 
similar  tests  were  especially  useful  for  the  study  of  disease 
of  the  cerebellum.  They  gave  the  exact  measure  of  those 
faculties  which  we  exercise  in  the  game  of  pinning,  blindfold, 
a  paper  tail  to  a  pajx^r  donkey  :  we  are  guided,  in  that 
orientation,  by  the  '  feel  '  of  our  joints  and  muscles.  The 
results  of  this  very  long  series  of  observations  were  as 
follows: 

I.  The  faculty  of  orientation  in  space,  as  determined  by 
the  muscular  and  arthrodial  sense,  progressively  diminishes 


i82  SIR  VICTOR  HORSLEY 

from  the  surface  of  the  body  outwards  to  the  Umits  of  the 
arm  extended  in  any  direction. 

2.  Orientation-knowledge  increases  in  passing  from  point 
to  point  in  the  space  around  the  body,  beginning  above  the 
head,  coming  down  to  the  front  of  the  body,  and  gradually 
approaching  the  centre  of  gravity  of  the  whole  body. 

3.  Orientation-knowledge  also  increases  in  passing  from 
point  to  point  in  the  space  around  the  body,  beginning 
laterally,  e.g.  in  the  plane  of  the  shoulder,  and  approaching 
the  mesial  sagittal  plane  of  the  body. 

3.  The  third  paper  was  written  with  Dr.  Colin  K.  Russel ; 
and  was  issued  from  the  Neurological  Department  of  Queen 
Square.  Like  Horsle3''s  paper  in  1904  on  tactile  sensation, 
it  is  concerned  with  our  ability  to  identify  the  exact  position 
of  a  touch  on  the  skin.  The  ill-sounding  name  of  topognosis, 
i.e.  knowledge  of  position,  had  been  given  to  this  abiUty.  It 
had  long  been  of  interest  to  physiologists  :  Horsley,  so  far 
back  as  1885-86,  had  observed  that  it  may  be  impaired  by 
injury  or  disease  of  the  cortex.  But  there  are  two  ways  of 
estimating  topognosis  :  and  Horsley  and  Colin  Russel  now 
called  attention  to  that  way  which  up  to  1906  had  been 
overlooked.  Take,  for  example,  the  upper  limb.  We  may 
regard  it  as  made  up  of  segmental  groups  of  muscles,  from 
end  to  end  of  its  length  :  or  we  may  regard  it,  by  analogy 
with  the  fore-limb  of  a  quadruped  animal,  as  made  up  of 
pre-axial  and  post-axial  groups  of  muscles,  from  front 
to  back. 

In  the  spinal  cord,  the  representation  of  the  sense  of  touch 
in  the  upper  limb  is  arranged  according  to  the  axis  of  the 
limb,  not  according  to  its  segments.  That  is  to  say,  the 
distinction  between  the  pre-axial  and  the  post-axial  groups 
of  muscles  is  maintained  in  the  arrangement  of  the  nerve- 
fibres  of  the  cervical  portion  of  the  cord.  This  fact  had 
been  known  for  some  years  :  but  nothing  was  known 
about  the  re-representation  of  this  distinction  at  any  higher 
level. 

In  1894,  in  a  patient  with  disease  of  the  brain,  affecting  the 
area  of  the  middle  cerebral  artery,  Horsley  found  '  marked 
dissociation  between  the  pre-axial  and  post-axial  reaction 
to  light  touches.     The  patient,  who  was  a  higlily-trained 


FROM   1899  'fC)  1906  183 

scientific  observer,  had  himself  previously  recognised  a 
certain  sense  of  loss  of  relative  knowledge  of  the  sides  of  the 
fore-limb.'  That  is  to  say,  there  was  impairment  not  only 
of  his  ability  to  judge  at  what  point  of  the  length  of  the  limb 
he  was  touched,  but  also  of  his  ability  to  judge  whether  he 
was  touched  on  the  pre-axial  or  on  the  post-axial  aspect  of 
the  limb. 

With  this  case  to  guide  them,  Horsley  and  Colin  Russel 
examined  a  series  of  cases  of  disease  of  the  brain,  at  Queen 
Square  and  in  private  practice.  In  all  of  them,  there  was 
'  a  topognostic  error  of  response  to  light  touches  :  in  two 
directions  at  right  angles  to  each  other.'  There  was  not  only 
a  '  segmental  error,'  there  was  also  a  '  post-axial  or  pre- 
axial  error.'  So  the  conclusion  is  reached,  that  what  '  may 
properly  be  termed  the  mid-axial  line  and  region  of  the  hand 
and  fore-arm '  are  represented  in  the  cord,  and  re-represented 
in  the  brain. 

In  July,  the  Horsleys,  with  their  children,  went  to  Toronto 
for  the  meeting  of  the  British  Medical  Association.  The 
University  conferred  on  him  the  degree  of  a  Doctor  of  Law. 
On  August  22,  he  gave  the  Address  in  Surgery.  At  a  meet- 
ing of  the  Section  of  Physiology,  he  gave  an  account  of  his 
most  recent  work  with  R.  H.  Clarke.  At  a  luncheon  of  the 
Ontario  Branch  of  the  Dominion  Temperance  Alliance,  he 
and  Sims  Woodhead  spoke  to  an  audience  of  500.  At 
the  festival  dinner  of  the  Association,  a  speech  was  loudly 
demanded  from  him  ;  and  he  spoke,  on  the  impulse  of  '  what 
was  uppermost  in  his  mind  at  the  moment,'  of  the  need,  in 
the  old  country,  to  raise  the  wage-earning  capacity  of  his 
profession.  '  It  was  a  question  of  improving  the  conditions 
of  each  one.  Not  only  that  :  it  meant  that  the  occurrence 
of  misfortune  to  the  members  of  the  great  army  of  medical 
men  might  be  prevented.' 

The  Address  in  Surgery  is  one  of  his  most  important 
writings.  It  was  just  twenty  years  since  he  had  shown,  at 
the  Brighton  meeting,  his  first  three  patients.  He  now 
reviewed  the  whole  field  of  brain-surgery  ;  with  special 
reference  to  his  own  cases  of  cerebral  tumour  at  Queen 
Square.     He  spoke  of  the  want  of  definite  agreement  over 


i84  SIR  VICTOR  HORSLEY 

the  question,  How  long  ought  such  cases  to  be  under  medical 
treatment,  before  consulting  a  surgeon  ?  At  Queen  Square, 
the  period  tended  to  be  about  three  months.  '  This  view  of 
the  situation,  unfortunately,  has  not  yet  been  discussed  in 
the  profession.  Even  in  the  present  year,  I  have  been 
asked  to  operate  on  a  patient  with  a  lateral  tumour  of  the 
cerebellum  who  had  been  known  to  have  optic  neuritis  for 
nine  years,  and  last  year  I  did  operate  on  such  a  patient  who 
had  been  known  to  have  optic  neuritis  for  thirteen  years.' 
Next,  he  spoke  of  the  very  great  value  of  decompression  for 
the  arrest  or  improvement  of  optic  neuritis  :  that  was  the 
fact  on  which  he  was  always  insisting,  that  the  intra-cranial 
pressure  can  be  relieved,  in  cases  where  nothing  more  can 
be  done  :  and  at  this  meeting  he  showed  such  lantern- 
photographs  of  optic  neuritis  as  might  well  be  called  sensa- 
tional. Next,  the  general  principles  of  brain-surgery,  and 
the  details  of  operating — '  Virtually,  it  will  be  found  that  the 
fundamental  purpose  of  every  detail  is  the  prevention  of 
shock  and  the  maintenance  of  the  physiological  integrity  of 
the  nervous  system.'  For  the  prevention  of  shock,  it  was 
necessary  that  the  anaesthetic  should  be  rightly  given.  His 
experiments  in  1883-85  had  taught  him  the  disadvantages 
of  ether-anaesthesia.  For  his  earlier  operations,  he  had  com- 
bined morphia  with  chloroform  :  later,  he  had  used  chloro- 
form only.  The  percentage  of  the  vapour  ought  to  be 
exactly  controlled  :  between  2'0  and  0*5  per  cent.,  according 
to  the  sensitiveness  of  the  parts.  For  the  treatment  of  the 
brain  itself,  less  than  0-5  sufficed  :  the  anaesthetic  might  even 
be  shut  off  altogether  for  some  minutes.  A  cylinder  of 
oxygen  was  adjusted  to  the  inhaler,  that  venous  congestion 
and  capillary  bleeding  might  be  checked,  at  any  moment  of 
the  operation,  by  giving  oxygen  instead  of  chloroform. 

Finally — after  speaking  of  each  step  in  operating,  and  of 
the  variable  risk  of  shock,  and  of  the  low  resistance  of 
the  central  nervous  system  against  wound-infection — he 
came  to  cases  of  cerebral  tumour  of  a  malignant  nature 
(glioma,  gho-sarcoma).  He  analysed  fifty-five  cases,  of 
which  he  had  the  complete  history  up  to  1906,  and  said 
that  the  outlook,  in  all  such  cases,  was  bad.     He  hoped  that 


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FROM  1899  TO  1906  185 

better  surgical  results  would  be  attained  with  earlier  diag- 
nosis. He  found  some  slight  hope,  also,  in  the  bare  possi- 
bility of  retrogressive  change  in  the  growth,  in  this  or  that 
case. 

In  December  of  this  eventful  year,  he  gave  an  address,  in 
Sheffield,  '  On  the  necessity  of  union  in  the  medical 
profession.' 


IV 
From  1907  to  August  1914 

1907-1908 

At  the  festival  dinner  in  aid  of  Queen  Square,  March  11, 
1907,  he  proposed  '  Success  to  the  Nervous  Diseases  Research 
Fund,'  and  described  the  work  that  was  being  done  by  Dr. 
Farquhar  Buzzard  on  the  bacteriology  of  diseases  of  the 
nervous  system,  and  by  Dr.  Gordon  Holmes  on  their  micro- 
scopic pathology.  He  spoke  hghtly  and  happily  :  he  made 
better  after-dinner  speeches  on  water  than  most  of  us  make 
on  wine. 

In  November  1907,  he  gave  evidence,  over  two  days, 
before  the  second  Royal  Commission  on  experiments  on 
animals.  He  was  closely  examined  as  to  a  series  of  experi- 
ments on  surgical  shock,  which  had  been  made,  with  his 
help,  by  Dr.  Crile,  Professor  of  Surgery  in  Cleveland  Uni- 
versity, lately  on  active  service  with  the  American  Army. 
The  experiments  had  been  severe  :  they  were  made,  of 
course,  on  animals  under  an  aniesthetic  and  killed  before 
recovering  from  the  anaesthetic  :  and  the  question  had  been 
raised,  whether  any  of  the  animals  had  been  capable  of 
feeling  pain.^  But  the  whole  of  Horsley's  evidence,  all  thirty- 
one  pages,  is  well  worth  reading.  One  part  of  it  is  of  especial 
interest ;  he  argued  against  that  clause  of  the  Act  which  says 
'  The  experiment  shall  not  be  performed  for  the  purpose  of 
attaining  manual  skill'  (Act  39  &  40  Vic,  c.  ^^j,  ss.  3,  6). 

'  Final  assurance  on  this  point  was  given  in  the  House  of  Commons, 
at  the  time  of  pubhcation  of  the  Report  of  the  Commission,  by  Lord 
Lamboume,  one  of  the  Commissioners.  He  had  no  bias  in  favour  of  experi- 
ments on  animals :  indeed,  at  the  time  when  the  Commission  was  appointed, 
he  belonged  to  one  of  the  anti-vivisection  societies.  He  stated  that  the 
Commissioners,  after  carefully  searching  through  the  whole  question, 
beheved  that  the  animals  used  in  these  experiments  were  absolutely  sense- 
less and  without  pain  (I'arliamentary  Debates,  xxxv.  20,  p.  1045). 
186 


FROM  1907  TO  AUGUST  1914  187 

He  described  the  use  made  of  this  method  at  the  Johns 
Hopkins  Hospital  :  and  he  divided  his  argument  under 
three  heads  : 

1.  The  need  of  teaching  students  Jww  to  operate. — '  The 
Commission  are  well  aware  that  at  the  present  moment 
the  only  practical  teaching  in  surgery  that  a  student  re- 
ceives, except  by  what  amounts  to  his  experiments  on 
human  beings,  is  from  operations  on  a  dead  body.  .  .  .  The 
texture,  and  the  method  of  dealing  with  the  Uve  tissue, 
is  quite  different  from  that  in  deahng  with  the  dead  tissue  ; 
and  from  the  ethical  point  of  view  it  seems  to  me  that  it 
is  not  moral  for  students  to  gain  their  knowledge  on  man 
when  they  can  perfectly  well  gain  it  on  an  anaesthetised 
lower  animal.  In  that  sense,  I  would  bring  the  use  of  animals 
for  education  in  surgery  on  to  exactly  the  same  level  as 
the  use  of  animals  for  food.  What  is  justifiable  for  the 
one  is  justifiable  for  the  other. 

2.  The  need  of  teaching  students  how  to  give  anasthetics. — 
'  I  wish  to  draw  the  attention  of  the  Commissioners  to  the 
fact  that  the  risk  of  death  from  anaesthesia  has  always 
been  justly  looked  upon  as  a  great  reproach  ;  and  I  wish 
to  express  my  personal  opinion  that  it  is  purely  a  matter 
of  knowledge  of  the  dose  required,  and  that,  as  regards  the 
education  of  students  in  anaesthetising  patients,  no  one 
ought  to  be  allowed  to  render  a  human  being  unconscious 
before  he  has  had  practice  on  animals.' 

3.  The  working  out  of  new  methods  in  surgery. — '  I  shall 
show  directly  that  many  of  the  operations  which  are  per- 
formed now  arc  based  entirely  on  experiments  on  animals  : 
but  I  would  hke  to  point  out  that  from  the  ethical  and 
moral  point  of  view,  it  seems  to  me  that  this  is  an  abso- 
lutely essential  procedure,  which  ought  to  be  adopted  before 
any  new  operation  is  carried  out  ;  for  the  reason,  that  if 
a  new  operation  upon  an  organ  or  tissue  of  the  body  is  per- 
formed, no  one  can  foretell  what  will  be  the  immediate  con- 
sequences to  the  animal  as  a  whole.  .  .  .  The  thing  is  either 
nKjral  or  immoral  ;  and  I  venture  to  suggest  that  any  new 
operation,  any  new  operative  method  or  procedure,  ougiit 
to  be  tried  on  an  animal  before  it  is  tried  on  man.' 


The  Act  is  more  than  forty  years  old  :  it  was  drafted  when 
things  were  very  different  from  what  they  are  now  :  and  the 
Commissioners  ought  to  have  recommended  some  modifica- 
tion of  this  clause. 

Other  events  of  Ujo'^  were  hib  election  to  the  Russian 


1 88  SIR  VICTOR  HORSLEY 

Surgical  Society  ;  and  the  publication  of  the  book  by 
him  and  Dr.  Mary  Sturge,  Alcohol  and  the  Human 
Body. 

In  February,  1908,  he  writes  to  Sir  Edward  Schafer  about 
the  founding  of  the  Research  Defence  Society  : 

I  quite  agree  with  you  about  the  Research  Defence  Society. 
It  must  have  local  branches,  and  these  must  consist  of 
as  many  non-medical  and  non-scientific  people  as  possible. 
I  will  not  have  anything  to  do  witli  it  if  it  is  going  to  be 
another  case  of  taxing  the  profession  for  maintaining  a 
thing  the  social  benefit  and  profit  of  which  accrues  to  the 
public  and  not  to  the  profession. 

On  March  12,  1908,  at  a  meeting  ol  the  Royal  Society,  his 
paper  was  read,  '  Description  of  the  Brain  of  Mr.  Charles 
Babbage,  F.R.S.'  This  relic  of  the  great  mathematician, 
the  inventor  of  the  calculating  engine,  had  been  for  thirty- 
six  years  in  the  Museum  of  the  Royal  College  of  Surgeons  : 
and  the  Council  of  the  College,  in  1906,  had  asked  Horsley 
to  report  on  it.  This  long  and  elaborate  report  was  one  of  the 
very  first  contributions  toward  the  foundation  of  a  true 
'  phrenology  ' — a  good  Greek  word  which  has  been  so  de- 
based that  men  of  science  dare  not  use  it,  though  it  is  just 
what  they  want.  But  there  was  nothing  very  remarkable 
in  this  particular  brain  :  except  that  it  bore  witness  '  as  to 
the  neurological  value  of  symmetry  as  a  feature  of  cerebral 
growth  in  an  individual  of  high  intellectual  abiUty  ;  and  as 
to  the  relative  development  of  the  areas  of  representation  of 
locutory  and  graphic  functions  in  contrast  to  sensorial 
representation.'  This  does  not  take  us  far  :  none  the  less, 
this,  and  this  alone,  is  true  phrenology.* 

At  the  Oxford  Ophthalmological  Congress,  in  July,  he 
spoke  on  optic  neuritis  :  and  again,  at  a  meeting  of  the 
Ophthalmological  Society  in  London.  He  had  a  strong  con- 
viction that  in  cases  of  cerebral  tumour  the  optic  neuritis 

'  Spitzka,  about  the  same  time,  published  his  '  Study  of  the  brains  of 
six  eminent  scientists  and  scliolars '  (Trans.  Amer.  Phiiosoph.  Soc, 
Philadelphia,  1907,  p.  175).  It  is  to  be  noted  that  Horsley,  in  his  will,  left 
his  skull  and  his  brain  to  the  Neurological  Society.  The  rest  of  his  body 
he  left  for  the  preparation  of  anatomical  specimens  for  the  museum  of 
Uoiver^uty  CoUoge. 


FROM  1907  TO  AUGUST  1914  189 

is  usually  more  marked  in  the  eye  which  is  on  the  same  side 
as  the  disease,  and  that  it  usually  shows  itself  first  in  a 
special  part  of  the  retina.  He  published  two  papers,  this 
year,  in  Brain :  one,  a  '  Note  on  the  existence  of  Reissner's 
fibre  in  higher  vertebrates ' :  the  other,  with  R.  H.  Clarke, 
*  The  structure  and  functions  of  the  cerebellum  examined 
by  a  new  method.' 

1.  Reissner's  fibre  had  been  described,  by  Sargent  of 
Harvard  and  others,  in  the  central  nervous  system  of  those 
lower  vertebrates  in  which  it  is  most  developed,  especially 
in  the  frog  and  the  fish  :  but  it  had  not  been  observed  in  any 
creature  so  high  as  the  monkey.  Horsley  therefore  went 
through  his  great  collection  of  microscope-sections  of  the 
brains  of  monkeys,  and  found  three  slides  which  showed  it. 
From  the  physical  peculiarities  of  this  curious  solitary 
microscopic  fibre,  and  especially  from  its  resistance  to  the 
ordinary  conditions  of  degeneration  of  nerve-fibres,  he  was 
disposed  to  regard  it  not  as  an  integral  part  of  the  nervous 
system,  but  as  a  vestige  of  a  skeletal  structure. 

2.  The  paper  with  R.  H.  Clarke,  eighty  pages  long,  is  a 
description  of  method  only,  not  of  results.  In  1905,  they 
had  not  needed  to  differentiate  lesions  of  the  cerebellar 
nuclei  from  lesions  of  the  cerebellar  cortex  :  and  the  problem 
was  still  before  them,  to  produce  a  lesion  exactly  limited  to 
this  or  that  nucleus,  without  doing  violence  to  the  overlying 
cortex.  They  required,  to  begin  with,  a  complete  series  of 
sections  of  cerebella,  2  mm.  thick,  cut  in  three  planes, 
sagittal,  frontal,  and  horizontal  :  these  were  to  serve  as 
charts  or  indicators.  The  special  microtome  for  this 
purpose  was  devised  by  R.  H.  Clarke  :  who  also  devised  a 
stereotaxic  apparatus,  probably  the  most  complex  of  all  the 
mathematical  instruments  of  physiology,  for  the  exact 
directing  of  an  insulated  electrolytic  needle  by  graduated 
movements  in  three  planes.  Thus  moving  by  hairsbreadtlLs, 
and  on  planes  exactly  determhicd,  they  were  able  to  produce 
a  minimal  electrolytic  lesion  of  a  cerebellar  nucleus,  without 
involving  the  cerebellar  cortex.  This  was  the  first  use  of 
electrolysis  in  experimental  physiology. 

Among  the  workers  in  llursley's  laboratory  during  1907-08 

k 


I90  STR  VICTOR  HORSLEY 

was   Dr.   Ernest   Sachs,   of  the   University  of  St.   Louis  : 
who  writes  : 

I  had  the  rare  privilege  of  working  with  him  from  September 
1907  to  December  1908.  Though  I  was  a  total  stranger  to 
him,  he  took  me  into  his  laboratory,  and  had  me,  at  times 
almost  daily,  in  his  home  in  Cavendish  Square. 

I  recall  incidents  which  have  always  seemed  to  me  typical 
of  his  character.  On  a  certain  Sunday — we  always  made 
rounds  in  the  National  Hospital  on  Sunday  morning,  and 
he  would  pick  me  up  in  his  machine  on  his  way  to  the  Hospital 
— as  I  entered  the  car  he  said,  '  You  have  heard  the  news  ? 
The  walrus  died.'  I  had  not  heard  it,  and  wondered 
why  he  was  so  enthusiastic  over  it,  but  his  next  sentence 
explained  it.  It  was  the  first  walrus  that  had  been  autopsied 
in  London  for  many  }Tars.  He  was  to  do  a  Gasserian  gang- 
lion the  following  morning,  and  the  autopsy  of  the  walrus 
had  been  set  for  9  o'clock  at  the  Zoological  Gardens.  He 
asked  me  to  breakfast  with  him  at  about  6,  and  then  went 
to  the  nursing  home  and  did  the  ganglion  in  his  masterly 
way,  dressed  rapidly,  and  dashed  downstairs  to  get  to  the 
Zoological  Gardens  in  time.  As  we  entered  the  machine, 
I  asked  whether  the  autopsy  would  not  interfere  seriously 
with  his  consultations  for  the  morning  :  and  he  said,  '  If 
people  want  me  to  continue  to  improve  myself,  they  must 
wait.'  As  soon  as  we  reached  the  Gardens,  he  dashed 
over  to  the  appointed  place  and — though  there  was  snow 
on  the  ground — in  his  shirt-sleeves  took  out  the  brain  of 
the  walrus,  and  returned  to  attend  to  his  daily  routine. 

Another  incident,  that  I  always  felt  was  typical  of  his 
industry,  was  at  Christmas  1907.  A  number  of  us  were 
spending  the  Christmas  week  with  him,  and  were  busy  every 
day  with  shooting,  walking,  or  golf,  in  all  of  which  under- 
takings he  was  the  leader  :  and  then  when  the  rest  of  us 
sat  round  at  tea  in  the  afternoon,  he  would  be  examining 
microscopic  sections,  and  joining  in  the  conversation  that 
was  going  on. 

One  incident  more  seems  to  be  characteristic.  When  I 
presented  to  him  a  manuscript  of  a  piece  of  work  that  I 
had  been  doing  in  his  laboratory,  I  naturally  had  put  his 
name  as  well  as  mine  at  the  top  of  the  article.  He  quietly 
crossed  his  name  out,  saying,  '  You  have  done  most  of  this 
work  ;  and  as  long  as  people  have  the  habit  of  giving  credit 
for  a  piece  of  work  to  the  one  whose  name  is  better  known, 
I  won't  let  my  name  appear.' 

Of  the  many  privileges  that  I  have  had  in  my  hfe,  work- 
ing with  various  big  men,  that  year  and  a  quarter  I  spent 
with  him  I  prize  as  the  most  valuable  and  delightful  I  ever 


FROM  1907  TO  AUGUST  1914  191 

had.  I  went  to  him  in  order  to  take  up  neurological  surgery, 
and  ever  since  my  return  to  this  country  I  have  devoted 
myself  to  that  work. 

1909  {cBt.   52) 

Lesser  events  of  the  year :  (i)  On  February  16,  at  a 
meeting  of  the  Medico-Legal  Society,  Mr.  Bernard  Shaw 
gave  an  address  on  '  The  Socialist  criticism  of  the  medical 
profession ' :  and  Sir  T.  Clifford  Allbutt  and  Horsley  spoke 
in  the  discussion.  (2)  On  March  6,  at  the  Royal  Society 
of  Medicine,  Horsley  took  part  in  a  discussion  on  vertigo. 
(3)  On  October  20,  he  distributed  the  prizes  at  the  London 
School  of  Dental  Surgery.  The  Government  Committee 
on  Anaesthesia  had  lately  been  appointed,  and  the  Anaes- 
thetics Bill  was  under  consideration  :  and  he  spoke  of  the 
improved  teaching  of  anaesthetics  to  dental  students.  (4)  On 
November  13,  at  University  College,  Cardiff,  he  gave  an 
address  on  '  Housing  and  Alcoholism.' 

In  Brain,  this  year,  he  and  Dr.  MacNalty  published  their 
paper  on  the  cerebellum.  They  had  thoroughly  studied,  by 
the  experimental  method,  [a)  the  tracts  of  nerve-fibres 
passing  from  the  cervical  spinal  cord  to  the  cerebellum, 
(b)  the  relation  of  the  cerebellum  to  the  nerves  of  the  fore- 
limb,  (c)  the  co-ordinating  action  of  the  cerebellar  cortex. 
They  state  their  conclusions  as  follows  : 

Each  part  of  the  spinal  cord  must,  practically  speaking,  be 
represented  in  every  unit  of  the  cortex  to  which  the  fibres 
run.  From  the  point  of  view  of  afferent  function,  there 
cannot  be  said  to  exist  any  evidence  of  differentiation  of 
the  cerebellar  cortex  into  localised  receiving  stations  for  the 
impressions  which  ascend  from  the  ann,  trunk,  or  leg  muscles, 
joints,  etc.,  respectively.  It  would  appear,  therefore,  that 
the  cerebellar  cortex  is  a  structure  in  whicii  tliese  muscular- 
sense  impressions  are  associated  together,  or — to  use  a 
more  frequently  employed  expression — co-ordinated. 

On  February  27,  at  Queen  Square,  Horsley  gave  the  most 
notable  of  all  his  clinical  lectures  :  '  On  chronic  spinal 
meningitis.'  He  had  operated — it  is  a  remarkable  instance 
of  the  amount  of  his  practice  in  the  surgery  of  the  nervoas 
system — on   no   less    than    twenty-one  cases  of    tliis  rare 


192  SIR  VICTOR  HORSLEY 

disease,  opening  the  sheath  of  the  cord,  and  irrigating  it 
with  a  mercurial  lotion  ;  and  this  without  a  death.  One 
patient  had  died  of  heart  disease,  six  weeks  after  the  healing 
of  the  operation-wound. 

On  June  25,  at  a  meeting  of  the  West  London  Medico- 
Chirurgical  Society,  he  gave  the  Cavendish  Lecture.  He 
spoke  of  the  relation  of  the  cerebellum  to  such  movements  as 
walking  and  balancing  ;  of  the  influence  of  the  reflex  system 
over  all  such  movements,  and  of  Sherrington's  invaluable 
work  on  this  subject;  and  of  the  cross-movements  of  the 
arms  and  the  legs  in  walking — '  we  are  not  single  animals  : 
we  are  really  two  individuals  joined  together  in  the  middle 
line.'  Then,  speaking  of  the  association  between  the  cere- 
bellum and  the  vestibular  part  of  the  internal  ear,  he  de- 
scribed two  cases  of  birds,  a  hen  and  a  homing  pigeon,  which 
had  suffered  from  unilateral  disease  of  the  internal  ear.  In 
each  case,  the  bird  displayed  the  so-called  cerebellar  attitude 
of  the  head — '  it  should  be  spoken  of  as  the  vestibular 
attitude.'  The  keen  interest  which  he  took  in  these  birds 
is  shown  by  the  many  notes  and  photographs  which  he  made 
of  them.^ 

In  July,  at  the  Belfast  meeting  of  the  British  Medical 
Association,  he  gave  an  address  on  optic  neuritis.  He 
resolutely  defended  the  position  which  he  had  taken,  the 
year  before,  in  Oxford  and  London  :  and  he  backed  his 
clinical  evidences  with  a  great  series  of  photographs. 

On  November  22,  at  a  meeting  of  the  Medical  Society  of 
London,  he  spoke  of  the  operative  treatment  of  trigeminal 
neuralgia.  He  had  at  tliis  time  done  149  operations  for 
the  removal  of  the  Gasserian  ganglion.  The  mortahty  had 
been  seven  per  cent.  But  this  applies  only  to  patients  over 
fifty  years  of  age  :  he  had  not  lost  any  patient  under  fifty. 
The  chief  risk  of  the  operation  was  from  arterio-sclerosis, 
which  is  common  among  those  who  suffer  from  trigeminal 
neuralgia. 

But  the  best  of  his  many  lectures  and  addresses  of  this 

*  Notes  and  a  sketch  have  come  to  hand  of  a  similar  case,  a  cock,  which 
he  saw  and  studied,  in  1885,  at  the  Brown  Institution  :  doubtless  the  first 
observations  ever  made  on  this  condition  in  poultry. 


FROM  1907  TO  AUGUST  1914  193 

year  was  the  Linacre  Lecture,  which  he  gave  before  the 
Master  and  Fellows  of  St.  John's  College,  Cambridge.  It  is 
perhaps  the  most  '  philosophical '  of  all  his  writings  :  and, 
from  the  fine  style  in  which  he  had  it  pubhshed,  he  seems  to 
have  been  justly  proud  of  it.  He  took  once  more,  for  his 
subject,  '  The  fimction  of  the  so-called  motor  area  of  the 
brain  '  ;  and  spoke  as  it  were  the  epilogue  to  his  work  in 
this  field  of  physiology  :  spoke  it  with  authority,  and  with 
faultless  dignity.  It  was  twenty-three  years  since  he  had 
submitted  to  the  Neurological  Society,  in  December  1886, 
his  theory  that  the  more  superficial  cells  of  the  motor  area 
were  '  probably  sensory,'  and  the  deeper  cells  were  '  probably 
motor.'  He  had  made  this  suggestion,  as  he  now  says,  '  on 
somewhat  slender  grounds  '  :  but  the  work  of  Mott,  Ramon 
y  Cajal,  and  others,  had  shown  the  truth  of  it.  But  so 
many  thousands  of  observations  had  been  accumulated, 
since  1886,  by  workers  in  science  and  practice  in  all  civilised 
countries,  that  he  felt  the  need  of  getting  back  to  first 
principles.  Besides,  he  was  addressing  an  audience  of 
learned  men,  but  not  of  physiologists.  So  he  starts  from  the 
primary  fact  that  '  there  is  no  such  thing  as  a  purely  motor 
centre  in  the  cortex  cerebri  '  : 

The  true  method  of  regarding  the  anatomical  construc- 
tion of  the  cortex  cerebri  should  begin  by  accepting  the 
principle  first  enunciated,  by  HughHngs  Jackson,  from 
the  consideration  of  the  nervous  system  from  the  evolu- 
tionary standpoint— namely,  that  every  centre  in  the  nervous 
system  must  be  scnsori-motor.  Such  a  thing  as  a  pure 
motor  centre  could  not  exist ;  since  it  would  be  unfur- 
nished with  the  causative  sensory  mechanism  essential 
to  the  occurrence  and  production  of  the  motor  or  efferent 
imj)ulsc  ;  and,  in  fact,  a  muscular  action  would  be  an  effect 
without  a  cause — an  absurdity  which  indeed  the  old  idea 
of  psychic  spontaneity  of  action  involved. 

That  is  to  say,  at  every  level  of  the  central  nervous  system, 
incoming  impulses  are  stored  and  '  memorised  '  and  made 
antecedent  to  outgoing  impulses.  He  takes  only  one  level, 
the  highest,  and  one  area  at  that  level :  he  takes  the  cortical 
representation  of  the  movements  of  the  upper  limb — '  which 
part  of  the  body,  including  as  it  does  some  of  the  most 
liighly    trained    combinations    of    sensation,    is    specially 

N 


T04  SIR  VICTOR  IIORSLEY 

.worthy  of  study.'  He  descril)es  the  work  recently  done  on 
this  area  :  he  acknowledges  that  one  of  the  conclusions  from 
his  work  with  Beevor  has  been  corrected  by  Sherrington  and 
Griinbaum  :  but  this  problem  of  physiology — as  to  the 
excitability  or  non-excitability  of  the  post-central  gyrus — 
does  not  annul  the  fact  that  the  whole  arm  area,  from  the 
point  of  view  of  surgery,  is  Umited  to  the  pre-central  gyrus. 
So  he  comes  to  the  final  question,  What  are  the  powers  em- 
bodied in  the  pre-central  gyrus  ?  What  sensory  impulses 
are  accumulated  in  it,  rendering  it  serviceable  to  the  move- 
ments of  the  upper  limb  ?  He  answers  this  question  with 
a  case  at  Queen  Square.  The  patient  was  a  boy  of  fourteen, 
afflicted  with  violent  convulsive  movements  of  the  left 
upper  limb  :   they  had  begun  when  he  was  seven  : 

He  was  in  a  very  distressing  condition,  and  was  referred 
to  me  by  Dr.  Risien  Russell,  with  the  view  of  arresting 
the  spasms  by  an  operation.  Having  stopped  athetoid 
and  clonic  movements  in  two  previous  cases  by  excision 
of  the  so-called  '  motor  '  area,  I  advised  that  the  arm-area 
in  this  case  should  be  delimited  by  excitation  and  then 
removed. 

On  March  20,  1908,  Horsley  exposed  the  right  pre-central 
and  post-central  gyri ;  mapped  out  exactly,  by  electrical 
stimulation,  the  whole  arm-area  (pre-central  gyrus)  ;  and 
removed  it.  The  convulsive  movements  immediately 
stopped  ;  and  more  than  a  year  later — at  the  time  of  the 
Linacre  Lecture — there  was  no  sign  of  any  return  of  them. 
Purposive  movements  began  to  return  a  month  after  the 
operation,  and  gradually  became  more  efficient :  he  attri- 
butes this  return  of  purposive  movements  chiefly  to  com- 
pensatory action  of  the  post-central  gyrus.  Tactile  sensation, 
the  '  feel '  of  the  muscles  and  joints  (muscular  sense,  arthric 
sense),  the  appreciation  of  temperature,  the  appreciation  of 
pain,  and  the  ability  to  identify  a  point  touched  (topognosis) , 
were  impaired  ;  and  there  was  profound  impairment  of  the 
ability  to  recognise,  by  contact,  the  shape  of  solid  objects 
(stereognosis)  : 

He  could  recognise  nothing  (nail-brush,  prayer-book, 
bottles,  coins,  knives,  pipe,  match-box)  when  the  objects 


FROM  jqny  TO  AUGUST  1014  105 

were  placed  in  his  hand,  and  even  when  the  fingers  were 
pressed  over  them  ;  though  he  once  guessed  a  tumbler 
to  be  a  bottle,  because  it  was  cold.  When  I  was  thus  test- 
ing him  for  stereognosis  three  weeks  after  the  operation, 
he  made  the  striking  remark,  '  If  I  could  only  move  my 
hand  about,  I  should  know  what  the  things  were ' :  thus 
showing  under  the  stress  of  effort  what  the  real  basis  of 
the  stercognostic  sense  is — namely,  merely  a  complex  of 
tactile,  muscular,  and  arthric  memories  of  movements, 
which  are,  in  fact,  the  compound  experiences  of  grasping 
and  feeling  objects. 

Thus,  from  this  one  case,  Horsley  was  able  to  say  that 
'  the  gyrus  pre-centralis  is  in  man  the  seat  of  representation 
of  (i)  slight  tactility,  (2)  topognosis,  (3)  muscular  sense, 
(4)  arthric  sense,  (5)  stereognosis,  (6)  pain,  {7)  movement.' 


1910  {^t.  53) 

The  General  Elections  in  January  and  December  of  this 
year  brought  him  with  a  rush  into  public  life.  In  the 
January  Election,  he  placarded  his  house  with  cartoons — 
the  big  loaf  and  the  little  loaf,  and  the  peer  and  the  working 
man — and  rented  a  hoarding  where  the  old  Vera  Street 
Post  Office  was  in  course  of  demolition.  In  the  December 
Election,  he  stood  for  the  University  of  London.  He  had 
made  up  his  mind,  long  before  1910,  that  when  he  was  sLxty 
he  would  retire  from  practice  and  enter  Parliament.  He 
failed  to  get  into  Parliament  :  and  he  did  not  live  to  win 
success  out  of  failure.  He  wrote  and  said  things  which  he 
might  well  have  left  unwritten  and  unsaid ;  he  fought  so 
angrily  for  female  suffrage  that  he  may  have  done  it  more 
harm  than  good  ;  he  made  sacrifice  of  himself,  losing  time 
and  money  and  health  and  peace  of  mind — all  this  when  he 
was  ov(;rworkcd  and  overstrained  and  burdened  with 
anxiety  over  the  lu'alth  of  one  who  was  very  dear  to  him — 
and  he  was  defeated  in  one  constituency  and  thrown  over  by 
anf)ther. 

But  it  is  to  be  remembered,  first,  that  he  never  for  one 
moment  regarded  politics  as  less  important  than  science 
and  practice,  never  doubted  of  the  necessity  and  the  right- 
eousness of  a  great  political  upheaval ;   fought  for  that,  not 


196  SIR  VICTOR  IIORSLEY 

for  his  own  ends.  Next,  that  it  was,  after  all,  only  a  few 
years  that  were  thus  embittered,  just  the  four  or  five  years 
before  the  War  :  politics,  in  those  evil  years,  had  venom  hid 
in  them  :  and  he,  unlike  St.  Paul,  when  there  came  a  viper 
out  of  tlie  heat,  and  fastened  on  his  hand,  was  not  able  to 
shake  off  the  beast  into  the  fire  and  feel  no  harm.  Last,  it 
is  to  be  remembered  that  the  course  of  events  has  already 
brought  unexpected  fulfilment  of  purposes  for  which  he 
fought. 

Three  honours  came  to  him  in  iqio.  In  March,  he  was 
elected  a  foreign  associate  of  the  French  Academy  of  Medicine. 
In  July,  he  was  elected  a  corresponding  member  of  the  Royal 
Prussian  Academy  of  Sciences.  At  the  meeting  in  London 
of  the  British  Medical  Association,  he  was  President  of  the 
Section  of  Surgery. 

In  Brain,  this  year,  he  and  Dr.  Otto  May  published  a 
paper  on  the  mesencephalic  root  of  the  trigeminal  nerve, 
giving  the  results  of  a  long  series  of  researches  into  its  centres 
of  origin. 

On  October  6,  in  Berlin,  at  the  annual  meeting  of  the 
German  Society  of  Neurologists,  he  gave  an  address,  '  On 
the  surgical  treatment  of  intra-cranial  tumour,  in  contrast 
with  the  expectant  medical  treatment.'  He  says  that  wait- 
ing, in  these  cases,  is  like  the  waiting  which  used  to  be  the 
rule  in  cases  of  appendicitis.  Seeing  that  the  only  result 
to  be  '  expected,'  in  a  case  of  cerebral  tumour,  is  the  death  of 
the  patient,  he  finds  the  stamp  of  inhumanity  on  the  phrase 
'  the  expectant  treatment.'  He  reviews  the  early  symptoms 
of  the  disoiLSc  ;   and  he  suggests  certain  rules  of  practice  : 

1.  Every  case  of  focalised  epilepsy  ^  not  definitely  proved 
to  bo  idiopatliic  in  origin  must  be  treated  by  exploratory 
operation. 

2.  Every  case  of  progressive  motor  or  sensory  paralysis  of 
intra-cranial  origin  must  be  treated  by  exploratory  operation. 

3.  Every  case  of  intra-cranial  tumour  definitely  diagnosed 
must  be  treated  according  to  its  situation,  cither  by  removal 
or  by  decompression. 

*  '  By  focalise<l  epilepsy  I  mean  all  varieties  of  epilepsy  in  which  the 
focus  or  starUng-point  of  the  seizure  can  be  localised  to  one  lobe  of  the 
cerebrum.' 


FROM  1907  TO  AUGUST  1914  197 

He  speaks  of  the  difficulties  involved  in  deciding  between 
these  two  procedures  ;  and  refers  to  a  case  in  which  the 
decision  was  made  not  by  him  but  by  the  patient.  He  is 
inclined  to  beheve  that,  '  except  in  the  case  where  the  field 
of  removal  involves  direct  destruction  of  the  representation 
of  such  a  single  faculty  as  speech,'  removal  slxjuld  be  the 
rule,  and  decompression  the  exception.  Decompression, 
he  says,  should  be  kept  for  those  cases  in  which  the  tumour 
is  known  to  be  in  a  position  from  which  it  caimot  be  safely 
dislodged,  and  those  cases  in  which  it  cannot  be  localised. 
He  adds,  that  in  one  or  two  cases  of  a  certain  kind,  he  has 
obtained  a  good  result  from  the  intra-cranial  use  of  a 
mercuric  lotion. 

In  November,  the  Liberal  Association  of  the  University 
of  London  invited  him  to  stand  for  the  University,  against 
Sir  Phihp  Magnus,  at  the  coming  Parliamentary  election. 
They  had  invited  him  on  a  former  occasion,  and  he  had 
declined  ;  now,  he  accepted.  He  writes,  on  November  23, 
to  Sir  Felix  Semon  : 

I  am  not  the  ungrateful  brute  I  appear  to  be  by  not  writing 
before  to  thank  Lady  Semon  and  yourself  for  (as  usual) 
much  kindness.  In  addition  to  my  other  work  I  am  con- 
testing the  University  of  London  scat,  and  unless  you  think 
Magnus  a  heaven-sent  statesman,  I  hope  you  wiU  recom- 
mend me  to  every  graduate  of  the  University  and  beg  him 
to  vote  for  me.  Yes,  I  was  greatly  pleased  with  the  Berlin 
friends.  It  is  the  greatest  scicntilic  lionour  1  have  received 
and  I  value  it  accordingly.  When  in  Berlin  a  month  ago,  I 
called  on  VValdcycr,  who  was  very  agreeable,  and  on  Munk, 
but  unfortunately  the  latter  most  chirpy  ancient  was  away. 
We  shall  most  assuredly  run  down  and  see  you  in  your  rural 
palace.  With  best  love  from  us  both  to  you  both — Yours 
as  ever. 

He  was  adopted  on  November  28,  nominated  (m  December 
3  :  only  a  few  days  before  the  election.  The  forces  of  anti- 
vivisection  were  of  course  employed  against  him.  Also,  a 
circular  was  sent  out  saying  that  hf,  in  i()02,  '  was  one  of  the 
signatories  to  a  letter  inviting  Sir  Philip  Magnus  to  contest 
the  seat  in  the  Unionist  interests  and  seeking  from  him 
assurances  i;f  his  "  political  adherence  to  the  general 
principles  of  the  Unionist  Party."  '     To  this  rather  >.habby 


198  SIR  VICTOR  HORSLEY 

score,  Horsley  answered  that  his  action  on  that  occasion 
'  was,  hke  that  of  other  graduates,  wholly  non-political,  and 
was  due  to  the  fact  that  the  sitting  member  had  not  acted 
constitutionally  towards  the  electors.'  It  is  possible  that 
he  regarded  his  candidature  as  more  or  less  of  an  experiment. 
He  and  a  University  constituency,  nine  yeai"s  ago,  were 
hardly  intended  for  each  other  :  and  on  December  lo,  Sir 
Philip  Magnus  was  declared  to  be  elected  by  a  large  majority. 
Mr.  Francis  Hyndman,  Hon.  Secretary  of  the  Liberal 
Association  of  London  University,  writes  of  Horsley's 
candidature  : 

He  asked  mc  to  be  his  agent  ;  so  that  I  came  into  close 
touch  with  him  and  with  his  home  for  some  time.  I  think 
perhaps  the  most  marked  character  I  noticed  was  his  hatred 
of  compromise,  even  that  smoothing  of  a  statement  or 
an  attitude  wliich  is  almost  essential  in  consolidating  the 
diverse  elements  in  a  constituency.  This  is  perhaps  more 
important  in  a  University  than  anywhere,  as  all  the  appeal 
has  to  be  documentary,  and  there  can  be  no  attempt  at 
anything  but  a  plain  statement  of  position.  He  was  of 
course  an  abstainer  of  the  most  uncompromising  kind,  and 
supported  his  views  with  a  wealth  of  scientific  argument 
and  data.  I  well  remember  his  relating  an  incident  which 
struck  me  at  the  time.  A  foreign  admirer,  Italian  I  think, 
had  sent  him  a  present,  which  liad  to  be  taken  out  of  bond 
and  cost  some  two  or  three  pounds.  On  opening,  it  was 
found  to  be  a  number  of  bottles  of  fine  liqueurs.  Wliat  did 
he  do,  present  them  to  a  hospital,  or  sell  them  and  give 
the  money  ?  No,  they  were  handed  to  the  children  to 
bum  :  and  they  said  they  burnt  very  well ! 

Another  incident  also  struck  me.  The  addressing  and 
distributing  agents  had  made  some  stupid  mistake  about 
a  number  of  important  papers  :  which  not  only  entailed 
considerable  extra  expense,  but  ran  the  chance  of  losing 
a  number  of  votes,  because  essential  papers  did  not  arrive 
until  the  last  moment.  He  took  a  most  easy-going  view, 
and  reproved  me  in  a  friendly  way  for  having  written  a 
strongly  condemnatory  letter  :  and  after  all  it  mattered 
to  him  and  not  to  mc  in  the  end.  What  interested  mc 
was  the  general  kindliness  of  his  point  of  view. 

London  University  gave  liim  no  chance  ;  as  the  majority 
of  his  own  profession,  which  is  the  largest  and  the  most 
uncertain  in  its  votes,  were  certainly  against  him,  not  from 
any  defined  reason,  but  because  his  very  individuahty  and 
power  of  action  made  them  nervous  of  some  possible  attack 


FROM  1907  TO  AUGUST  1914  199 

on  their  rights  or  privileges.  The  scientific  people  were 
largely  for  him,  about  fifty  per  cent.,  I  think.  The  law, 
rather  strongly  against  him,  for  the  same  reason  as  the 
medicos. 

1911 

On  January  19,  1911,  the  Lannelongue  Prize  was  awarded 
to  him.^  It  had  just  been  instituted,  by  Professor 
Lannelongue  of  Paris  ;  a  gold  medal  and  5000  francs,  for 
the  surgeon  who  in  the  previous  ten  years  shall  have  done 
most  for  the  advancement  of  surgery  ;  to  be  awarded,  once 
in  five  years,  by  a  committee  of  surgeons,  representatives  of 
many  nations — Great  Britain  and  Ireland  ;  the  United 
States  and  Canada  ;  South  America  ;  Japan  and  China  ; 
Italy ;  Spain,  Portugal,  and  Mexico ;  Scandinavia  and 
Holland ;  Belgium  ;  Germany ;  Austria  and  the  Balkan 
States — one  representative  of  each  of  these  nations  or  groups 
of  nations.  Horsley  received  this  unexampled  honour,  the 
first  Lannelongue  Prize,  from  the  hands  of  the  President  of 
the  Soci^te  de  Chirurgie.  He  spoke  a  few  words  of  thanks, 
and  of  compliment  to  Professor  Lannelongue  ;  and  said  that 
his  own  country,  which  had  long  been  under  the  influence  of 
John  Hunter's  teaching,  had  later  come  under  the  influence 
of  Claude  Bernard,  who  had  joined  together  physiology  and 
surgery.  '  That  is  what  I  have  striven  to  realise.  Un- 
fortunately, if  surgical  science  advances  with  fair  rapidity, 
its  practice  progresses  more  slowly.  That  is  because  we  are 
held  in  bondage  by  traditions  from  which  we  have  difficulty 
in  freeing  ourselves.' 

At  the  Birmingham  meeting  of  the  British  Medical 
Association,  he  and  Dr.  Finzi  read  a  paper, '  On  the  action  of 
filtered  radium  rays  when  applied  directly  to  the  brain.' 
In  these  experiments,  they  had  filtered  off  the  less  pene- 
trating /:?-rays  ;  and  luid  used  the  radium  as  it  would  be 
used  in  surgical  practice.     They  came  to  the  conclusion  tluit 

'  Lady  Horsley  writes  to  a  friend,  '  Victor  has  been  awardetl  the  Lanne- 
longue prize,  for  the  greatest  advance  in  surgery  in  the  last  ten  years  ; 
and  goes  to  Tans  to  receive  a  gold  medal  an<l  a  douceur  of  ^^200.  And  a 
grateful  patient  in  Australia  luis  sent  us  a  white  kangaroo  !  I  Kings  at 
the  bell  tlicrcforc  make  us  extremely  nervous,  and  at  tho  first  approach 
of  a  railway  cart  1  prcparu  inybcli  fur  luslaut  flijiht.' 


200  SIR  VICTOR  HORSLEY 

radium  rays  '  exert  no  iiillueiice,  discoverable  by  present 
methods,  on  the  nerve  tissues,  but  do  cause  notable  changes 
in  the  blood-vessels.' 

In  November,  he  and  Dr.  Handelsmann  published  their 
'  Preliminary  note  on  experimental  investigations  on  the 
pituitary  body.'  They  had  made  a  very  long  series  of  ex- 
periments ;  Dr.  Handelsmann  had  planned  a  full  report  ; 
but  in  the  lirst  winter  of  the  War,  serving  as  a  surgeon  with 
the  Russian  army,  he  was  taken  prisoner  by  the  Austrians. 

Horsley  had  not  to  wait  long  for  a  second  chance  of  enter- 
ing Padiament  :  he  was  invited,  in  June  1911,  to  address  the 
North  Islington  Liberal  and  Radical  Association,  with  a 
view  to  being  their  candidate  at  the  next  election  :  he  was 
adopted,  and  during  igii-1912  did  a  great  deal  of  work  for 
the  constituency. 

1912-1913 

Two  more  honours,  in  1912  ;  from  Sweden,  and  from 
Italy.  In  May,  he  was  elected  a  member  of  the  Royal 
Society  of  Science  of  Upsala,  in  succession  to  Lord  Lister. 
In  December,  he  was  elected  an  honorary  fellow  of  the 
Itahan  Society  of  Neurology. 

On  January  19,  1912,  at  the  Royal  Society  of  Medicine,  he 
and  C.  E.  West  opened  a  discussion  on  the  factors  which 
help  toward  success  in  the  treatment  of  brain-abscess  follow- 
ing a  discharge  from  the  car.  On  February  13,  at  the  Royal 
Society  of  Medicine,  a  paper  by  Dunhill  of  Melbourne  was 
read,  '  On  partial  thyroidectomy  under  local  anaesthesia, 
with  special  reference  to  exophthalmic  goitre.'  James 
Berry,  Horsley,  and  many  others  took  part  in  this  discussion ; 
which  was  twice  adjourned,  because  of  the  number  of 
speakers.  On  March  27,  at  the  Hunterian  Society,  Horsley 
opened  a  discussion  on  the  therapeutic  value  of  alcohol  ; 
but  failed  to  win  sujiport  for  his  opinions.  At  the  Liver- 
pool meeting  of  the  British  Medical  Association,  he  read  a 
paper,  '  On  the  diagnosis  and  treatment  of  compression- 
paraplegia.'     Thes(;  all  are  epilogues  to  his  surgical  teaching. 

On  August  24,  he  and  Dr.  Agnes  Savill  and  Mr.  Mansell 


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FROM  1907  TO  AUGUST  1914  201 

MouUin  published  in  the  Lancet  their '  Prehminary  Report  on 
the  Forcible  Feeding  of  Suffrage  Prisoners.' 

Toward  the  end  of  191 2,  he  was  invited  to  stand,  at  the 
next  election,  for  the  Harborough  Division  of  Leicestershire  ; 
and  resigned  his  candidature  for  North  Islington.  On 
January  11,  1913,  he  was  adopted  by  the  Council  of  the 
Harborough  Liberal  Association. 

On  April  24,  1913,  he  spoke  at  a  meeting  of  the  National 
Conference  against  the  Opium  Traffic.  On  June  9,  he 
spoke  at  a  conference  in  Paris  against  the  State-regulation 
of  vice.  He  described  what  was  being  done  in  England 
against  it  ;  and  he  denounced  and  showed  up  the  notion  that 
sexual  intercourse  is  necessary  to  a  mans  health.  Then, 
dropping  English  and  speaking  in  French,  he  suddenly 
proposed  a  resolution  in  favour  of  female  suffrage.  '  We  are 
always  talking,'  he  said,  '  of  the  rights  of  man  :  we  ought 
therefore  to  talk  also  of  the  rights  of  woman.  In  England, 
we  hope,  at  a  time  not  too  far  off,  to  have  female  suffrage 
—  perhaps  restricted  —  still,  female  suffrage.  All  these 
questions  of  State-regulation,  all  these  social  questions, 
ought  to  be  decided  not  by  a  part  of  the  community,  but  by 
the  whole  community  together.' 

In  August,  the  great  International  Medical  Congress  was 
held  in  London,  under  the  Presidency  of  Sir  Thomas  Barlow, 
with  Sir  Wilmot  Hcrringham  as  General  Secretary  :  and  on 
August  II,  at  a  meeting  ni  the  Section  of  Neuropathology, 
there  was  a  discussion  on  the  treatment  of  cases  of  cerebral 
tumour.  The  year  before  the  Congress,  Dr.  Howard  Tooth, 
C.M.G.,  had  pultlished  a  minute  analysis,  from  the  point  oi 
view  of  pathology,  of  500  casts  of  cerebral  tumour,  at  Queen 
Square,  during  1902-1911.  He  had  studied,  with  the  very 
utmost  care,  what  may  be  called  the  natural  history  of  the 
tumours  of  a  malignant  nature,  the  gliomata — their  methods 
of  growth,  their  character,  their  vitality — and,  from  that 
point  of  view,  had  come  to  believe  stiongly  that  in  all  cases 
of  glioma  the  operation  for  decompression  was  preferable  to 
the  operation  for  removal  : 

If  these  appearances  arc  to  be  accepted— and  I  offer  them 
witii  the  greatest  possible  diflidence — one  is  forced  to  infer, 


202  SIR  VICTOR  UORSLEY 

on  pathological  grounds  ulone,  that  surgical  interference, 
exploration,  or  manipulation,  with  few  notable  exceptions, 
is  liable  to  awake  into  greater  activity  an  exuberance  which 
perhaps  may  be  almost  latent  at  the  time.  .  .  .  There  may 
be  some  hope  of  treatment  in  the  future  by  some  applica- 
tion of  ultra  rays  after  removal  of  the  bone,  such  as  has 
given  results  in  some  otiier  vascular  growths.  ...  It 
seems  that  in  the  present  state  of  our  knowledge  we  must 
be  content  witii  relieving  pressure  by  decompression  in  all 
gliomata,  lest  worse  befall. 

At  the  meeting  on  August  ii,  1913,  he  read  a  further  paper, 
'  On  the  treatment  of  tumours  of  the  brain,  and  the  indica- 
tions for  operation.'  He  now  had  analysed  265  operations, 
at  Queen  Square,  on  cases  of  cerebral  tumour,  of  all  kinds, 
malignant  or  non-malignant.  He  stated  his  conclusions  as 
follows  : 

There  must  always  be  a  high  mortality,  with  or  without 
operation  ;  but  every  surgeon  must  agree,  and  perhaps  still 
more  after  study  of  the  preceding  pages,  that  the  mortality 
is  probably  capable  of  reduction,  not  by  shrinking  from 
operation,  but  by  judicious  choice  of  the  fonn  of  operation, 
and  modification  of  procedure.  I  go  so  far  as  to  say  that 
the  period  of  surgical  activity,  of  which  this  report  has 
been  the  survey,  has  been  a  necessary  stage  in  the  develop- 
ment of  cerebral  surgery,  as  it  has  been  in  abdominal,  rectal, 
and  other  branches.  On  the  other  hand,  the  survivals 
also  present  many  briUiant  results,  lives  not  only  saved  but 
rendered  useful  and  indefinitely  prolonged.  But  close 
consideration  of  the  state  of  the  patient  in  the  less  fortu- 
nate survivals  may  well  raise  the  question  as  to  whether, 
by  less  energetic  and  extensive  surgical  treatment,  as  good 
or  even  better  results  could  not  have  been  obtained.  .  .  . 
The  fact  is  tliat  most  cases  of  declared  intra-cranial  tumour 
need  operation,  perhaps  sooner  than  later,  and  the  risk 
has  to  be  taken.  The  question  is  rather  what  class  of  opera- 
tion shall  be  selected. 


Horsley,  at  this  meeting,  spoke  of  the  hope,  which  never 
failed  him,  that  earlier  diagnosis  and  earlier  treatment 
would  improve  the  results  of  the  operation  for  removal  of  a 
tumour  of  the  brain.  Here  is  not  the  place  to  say  more  of 
these  difhculties,  in  surgery  and  in  ethics.  The  reader  must 
ask  himself  or  herself,  What  should  I  wish  to  be  done,  if  I 


FROM  1907  TO  AUGUST  1914  203 

were  suffering  from  the  disease,  or  if  one  of  my  family  were 
suffering  from  it  ? 

In  November,  came  the  end  of  Horsley's  candidature  for 
the  Harborough  Division.  The  Executive  Committee  were 
of  opinion  that  he  '  had  rendered  his  candidature  futile  '  ; 
and  they  gave  him  his  dismissal.  There  is  something  in  this 
Market  Harborough  episode  which  recalls  Dogberry's  charge 
to  the  watch  : 

You  shall  comprehend  all  vagrom  men  ;  you  are  to  bid 
any  man  stand,  in  the  prince's  name. 

How  if  a  ivill  not  stand  ? 

Why  then,  take  no  note  of  him,  hut  let  him  go  ;  and 
presently  call  the  rest  of  the  watch  together,  and  thank 
God  you  arc  rid  of  a  knave. 

But  they  had  no  doubt  that  he  was  '  endangering  the  seat ' ; 
and  their  business  was  to  keep  it  safe.  They  had  been  glad 
enough,  in  January,  to  get  him  :  and  he  had  put  his  views 
clearly  before  them.  They  had  let  him  know  that  the  con- 
stituency was  not  in  favour  of  female  suffrage  :  his  agent 
wrote  to  him,  January  6,  before  the  first  of  his  many 
addresses  to  audiences  in  or  near  Leicester  : 

Many  of  those  present  will  be  superior  agricultural  labourers 
who  are  not  quick  at  grasping  points,  but  if  slow  in  thought 
always  f,'ft  there — so  that  it  will  be  desirable  to  use  the 
simplest  language  and  emphasise  the  points.  They  have 
no  more  enthusiasm  for  '  Votes  for  Women  '  than  the  Execu- 
tive has — we  have  suffered  much  from  women  voters — so 
you  will  not  be  surprised  if  that  part  of  the  programme  is 

received  in  silence.     They  have  tolerated  it  from  Mr.  

in  consideration  of  his  other  articles  of  faith. 

So  far  as  he  could,  Horsley  took  this  advice.  He  did  not 
make  female  suffrage  the  chief  subject  of  his  addresses  ;  he 
never  made  it  the  only  subject  of  an  address  :  he  expounded 
the  whole  programme,  just  as  he  had  said  that  he  would  : 
he  covered  a  very  wide  range,  and  the  heckling  made  it 
even  wider.  At  fust,  everything  went  smoothly  :  he  writes 
to  a  friend,  January  13,  '  1  have  just  started  in  at  Market 
Harboro',  or  rather  the  Harboro'  Division  (South  half)  of 
Leicestershire,  quite  easily.  The  people  are  very  kind,  as 
also  they  have  been  in  North  Islington.'     On  June  25,  he 


204  SIR  VICTOR  IIORSLRY 

writes,  *  1  can  see  tliat  llie  Leicester  people  are  l)eginning  to 
realise  there  is  more  in  female  suffrage  than  they  thought. 
It  is  curious  to  see  how  backward  they  really  are  on  the 
point.'  But  the  fate  of  his  candidature  was  in  the  hands 
of  the  Council  of  the  Liberal  Association  :  and  in  July  he 
received  a  more  or  less  formal  intimation  that  he  was  in 
risk  of  being  thrown  over. 

Probably,  the  harm  wius  dune  not  by  what  he  said  in  the 
constituency,  but  by  what  he  was  saying  in  London  and 
writing  in  the  London  papers.  Some  of  these  papers  found 
that  his  unrestrained  sayings  were  '  good  copy ' :  for  example, 
his  speech  at  a  Queen's  Hall  meeting,  July  8,  1913,  on  the 
Temporary  Discharge  of  Prisoners  Act,  the  '  Cat  and  Mouse 
Act.'  He  so  hated  the  thought  of  women  being  forcibly 
fed  that  he  did  not  care  what  gibes  and  platform  epithets 
he  flung  at  the  Home  Secretary  and  others  :  he  just  let 
himself  go.  He  had  published  certain  statements  about 
forcible  feeding,  which  the  Home  Secretary  had  referred  to 
the  President  and  Council  of  the  Royal  College  of  Surgeons  ; 
they  had  declined  to  interfere.  Here,  said  Horsley  to  the 
meeting,  was  Mr.  McKenna — whom  he  nicknamed  Viscount 
Holloway — seeking  his  revenge  by  secret  intrigue.  '  Fancy 
a  Home  Secretary  thus  secretly  intriguing  against  private 
citizens.  .  .  .  What  an  end  to  a  backbiting  intrigue  by  a 
Minister  of  the  Crown.  Such  always  will  be  the  result  of 
changing  Government  by  Law  for  Government  by  a  bureau- 
crat and  secret  pohce.'  It  is  no  wonder  that  the  Harborough 
Association  was  frightened.  His  reverence  for  women,  his 
behef  in  their  intellectual  power,*  his  longing  for  their  rights 
and  their  welfare,  made  him  blind  to  the  impasse  in  which 
the  Government  was  held.  He  raged  against  things  as  they 
were,  but  could  not  suggest  any  escape  from  them  save 

•  Among  the  many  Idlers  from  his  patients,  one  has  come  from  a  la<ly 
on  wiiom  he  ojxjratcd,  in  1902,  for  di.sea.sc  of  the  spinal  cord  :  '  I  do  not 
think  a  nobler  hfe  has  been  lost  iluring  this  terrible  war.  .  .  .  Sir  Victor 
was  most  modest,  he  held  that  boys  inherited  their  brains  from  their 
mother,  and  frequently  put  in  his  letters  to  me  that  whatever  brains  his 
sons  possassed  they  inherited  from  their  mother.'  Among  the  profes- 
sional arlvantages  which  lie  hcl]>cd  women  to  obtain,  were  the  member- 
ship of  the  Physiological  Society,  and  admissloD  to  the  practice  of  Queen 
Square. 


FROM  1907  TO  AUGUST  1914  205 

by  unconditional  surrender  ;  and  this  when  the  mihtant 
suffragettes  were  still  at  their  criminal  offences,  and  the 
surrender  of  the  Government  to  them  against  the  will 
of  the  people  would  have  been  utterly  disastrous  and 
shameful.  He  could  not  or  would  not  see  that  '  govern- 
ment by  law  '  is  inseparable  from  government  by  legal 
punishment. 

Year  in  year  out,  he  and  Lady  Horsley  worked  together  in 
the  cause  of  female  suffrage  :  there  is  not  room  even  for  a 
bare  list  of  his  addresses  :  only  one  or  two  points  may  be 
taken  from  his  rough  notes.  He  believed  that  the  '  establish- 
ment of  democratic  rule  by  the  poHtical  enfranchisement 
of  all  men  and  women '  would  tend  to  prevent  war.  He 
believed  that  female  suffrage  would  be  powerful  against  the 
dishonour  of  women — '  Contempt  for  women  is  the  founda- 
tion of  sex-immorality.  Hence  the  anti-suffrage  movement 
is  the  cult  which  leads  to  woman's  degradation,  and  from  it 
to  prostitution.'  He  resented  the  indifference  of  so  many 
women  toward  the  cause  :  he  said  that  they  were  deliberiitely 
unpatriotic,  content  to  lead  a  selfish  life,  not  caring  either  to 
help  other  women  or  to  be  of  service  to  their  country.  He 
did  not  see  why  the  cause  should  be  set  aside  for  the  War : 
he  said  that  war-time  *  is  the  very  moment  when  the  need 
of  a  great  sense  of  civic  brotherhood  and  of  social  schemes 
for  helping  one  another  compels  people  to  study  the  principles 
of  human  politics.'  He  never  doubted  that  women  would 
vote  for  the  men  who  would  work  hardest  to  help  women  and 
children. 

The  notes  for  his  addresses  contain  also  many  quotations, 
to  be  used  some  with  approval  and  others  with  derision. 
Among  the  litter,  are  a  saying  of  Alcuin  to  Charlemagne, 
'  We  should  not  listen  to  those  who  are  wont  to  say  Vox 
populi  vox  Dei  :  for  the  noise  of  the  mob  is  very  near  to 
madness  ' ;  and  a  saying  of  Rousseau,  '  Being  incapable  of 
judging  for  themselves,  womtm  ought  to  accept  the  decision 
of  their  fathers  and  their  husbands,  like  those  of  the  Church.' 
Among  the  former,  are  Penn's  '  Liberty  without  obedience  is 
confusion,  and  obedience  without  liberty  is  slavery';  and 
two  of  John   Bright's  sayings,   '  1  have  nut   the  smallest 


2o6  SIR  VICTOR  HORSLEY 

objection  to  the  widest  possible  suffrage  that  the  ingenuity 
of  man  can  devise  '  ;  and  again,  '  The  people  who  talk  about 
danger  from  an  extension  of  the  franchise  are  hke  children 
who  are  afraid  to  go  to  l)ed  in  the  dark.'  Above  all,  he 
enjoyed  to  quote  Mr.  Asquith's  phrase,  '  The  free-will 
offering  of  a  free  people.' 

But  he  had  said  and  written  much  that  could  not  be 
washed  in  Lethe  and  forgotten  by  the  Harborough  Ex- 
ecutive :  and  they  asked  him  to  confer  with  them  on  his 
predicament.     He  writes  to  a  friend,  September  lo  : 

It  was  a  great  thought  of  yours  to  send  me  Trevelyan's 
Bright,  and  I  have  just  finished  it  with  much  gratitude  to 
you.  As  regards  the  lessons,  I  fear  that  my  cerebral  apparatus 
must  be  less  appreciative,  for  I  cannot  draw  from  the  book 
the  moral  that  compromise  is  in  principle  good.  I  rather 
learnt  the  opposite  from  my  precious  knowledge  of  J.  B.'s 
career.  ...  I  quite  of  course  intend  on  November  4th, 
which  I  think  is  my  date  for  meeting  my  executive,  to  be 
very  friendly  and  '  compromiseable.'  All  I  ask  is  for  plain 
speaking,  of  which  there  is  not  enough  in  the  poUtical  world. 
I  quite  recognise  method  is  requisite,  but  I  do  not  believe 
ever  that  method  should  conflict  with  principle  even  tem- 
porarily. 

He  attended  a  meeting  on  November  i  :  there  was 
another  meeting,  without  him,  on  November  8.  The 
Executive  Committee  passed  a  resolution  as  follows  : 

That  as  Sir  Victor  Horsley,  by  the  course  he  has  taken  in 
reference  to  Women's  Suffrage,  has  created  the  impression 
among  the  electors  of  the  Harborough  Division  (a)  Tiiat  he 
regards  that  as  the  most  important  question  before  the 
country,  (6)  That  he  docs  not  disapprove  of  the  lawless 
methods  of  the  miHtants,  (c)  That  he  would  not  hesitate 
about  sacrificing  a  Government  engaged  in  promoting  the 
most  momentous  reforms,  if  ministers  refused  to  run  counter 
to  tiic  wishes  of  the  great  majority  of  the  people  on  the 
Suffrage  question — and  as  he  has  thereby  rendered  his 
candidature  futile,  this  Committee  requests  the  officers 
to  seek  another  candidate. 

Horsley's  answer,  printed,  is  dated  November  17.  On 
point  (a),  he  answers  that  he  had  held  twenty -six  meetings  : 


FROM  1907  TO  AUGUST  1914  207 

ho  had  not  made  female  suffrage  his  chief  subject.     He  gives 
a  Hst  of  his  subjects  : 

The  Liberal  Programme  and  Government's  record  :  15 
meetings. 

Tariff  Reform  :    12  meetings. 

Land  Question,  Rating  Reform,  etc.  :   11  meetings.* 

Labour  and  Social  Questions  :  9  meetings. 

Finance  :   7  meetings. 

Franchise  Bill,  Adult  Suffrage,  and  Plural  Voting :  7 
meetings. 

Insurance  Act :   5  meetings. 

Temperance  Legislation  :   2  meetings. 

On  point  {b),  he  answers  that  he  had  said  plain!}'  and  often 
that  he  was  not  in  favour  of  mihtancy.  On  point  (c),  he 
answers  that  the  statement  is  baseless,  and  that  no  oppor- 
tunity of  repudiating  it  has  been  given  to  him.  Finall3^  he 
says  : 

I  would  emphasise  the  fact  that  the  present  issue  is  not 
one  of  my  personality,  or  of  my  predilections  for  a  con- 
stituency in  which  I  have  found  so  many  friends,  but  whether 
a  Liberal  candidature  is  to  be  determined  on  an  open  ques- 
tion or  upon  the  whole  series  of  social  refonns  wliicli 
constitute  the  legislative  programme  of  the  Liberal  party. 
This  latter  was  your  view  when  you  adopted  me  as  the  pro- 
spective candidate  for  the  Harborough  Division,  it  was  also 
my  view,  and  I  have  not  departed  from  it. 

On  November  19,  one  of  the  chief  men  of  Leicester  writes 
to  him  : 

I  could  not  be  faithful  to  you  if  I  did  not  frankly  express 
to  you  what  my  experience  has  iDcen.  I  fmd  the  consensus 
of  opinion  is  that  }'our  chances  of  success  are  gone,  as  there 
is  a  very  strong  fcchng  against  tlie  sympathy  you  have 
shown  to  the  militant  side  (jf  tiie  suffragette  movement.  ,  .  . 

told    me    strongly    that,    from    his  own    knowledge, 

from  every  part  of  the  division,  he  had  strong  testimony 
from  the  workers,  that  it  would  be  useless  for  your  cancH- 
daturc  to  continue  with  any  certainty  of  success.  ...  I 
may  say  it  is  very  painful  to  me  to  make  this  communi- 
cation t(i  you.  and  I  wish  I  had  not  to  writ(\  l)ut  I  cannot 
be  faithful  to  you  if  I  withhold  from  you  what  I  have  heard. 

»  He  was  a  Vicc-Prcsitlcnt  of  the  Associalion  for  llic  Taxation  of  Land 
Values  :  he  resented,  lie.irt  and  soul,  tlic  jiossession  of  huge  estates  in 
London  by  a  few  landowners  of  prodigious  wealtli. 


208  SIR  X'lCTOR  HORSLEY 

A  few  days  later,  the  Council  of  the  Association  held  a 
final  meeting,  at  which  Horsley  took  leave  of  them  with  all 
dignity,  and  they  of  him  with  such  dignity  as  they  could 
command.  He  generously  remained  a  good  friend  to 
Leicester,  interesting  himself  in  plans  for  its  welfare.  He 
was  '  approached,'  between  January  1914  and  May  1915, 
on  behalf  of  four  constituencies.  The  last  of  these  four  offers 
came  to  him  just  as  he  was  leavmg  for  Egypt.  He  writes 
back,  on  May  17,  1915  : 

I  am  certainly  anxious  to  get  into  Parliament,  and  par- 
ticularly to  represent  a  Northumberland  or  Durham  con- 
stituency. I  would  gladly  have  come  to  Gateshead  to  talk 
it  over  with  you,  but  am  just,  in  half  an  hour,  embarking 
with  a  division  of  the  Dardanelles  Force  as  Surgcon-in-chief 
of  a  Hospital,  Surgical  Division.  I  therefore  may  not  be 
at  liberty  for  many  months.  This  may  render  me,  in  the 
eyes  of  the  Liberal  Association,  as  unknown  to  them,  an 
impossible  candidate.  But  I  hope  not.  Further  I  am  sure 
that  the  Labour  party  would,  under  present  circumstances 
particularly,  so  far  approve  my  candidature  as  a  Liberal 
that  they  would  not  oppose  me.  At  least  I  have  every 
reason  to  think  so.  I  am  extremely  well  known  to  the 
Labour  leaders. 

Last  of  all,  an  offer  from  Huddersfield.  H  he  had  lived  to 
come  back  from  Mesopotamia,  there  was  that  constituency 
wanting  him.  For  on  March  23,  1915,  he  had  given  an 
address  in  Huddersfield,  which  had  won  him  much  goodwill : 
he  went  to  France  on  March  28  :  but  the  Huddersfield 
Liberals  made  up  their  minds  to  wait  for  him.  There  is  a 
letter,  written  six  days  after  his  death,  to  his  elder  son, 
Captain  Siward  Horsley,  Gordon  Highlanders,  from  the 
President  of  the  Huddersfield  Liberal  Association  : 

We  held  a  meeting  this  afternoon,  to  bring  forward  your 
father's  name  as  a  likely  candidate  for  our  town's  representa- 
tion in  Parliament.  His  was  tlie  only  name  to  be  con- 
sidered, and  I  have  no  doubt  tliat  it  would  have  been  gladly 
and  unanimously  welcomed.  All  that  we  could  do  was 
to  bow  to  a  Higher  call,  and  lament  our  loss.  I  was  unani- 
mously asked  to  convey  to  you  and  your  family  our  deepest 
sympathy  ;  and  to  say  that  we  share  your  loss  and  sorrow 
with  you.  I  find  tiiat  Sir  Victor  was  well  known  in  this 
district,  and  higlily  honoured  :    and  we  all  feel  that  it  is  a 


FROM  1907  TO  AUGUST  1914  209 

national  bereavement  :  but  the  memory  of  his  noble  hfe 
and  great  sacrifice  will  be  fragrant  for  many  years  to 
come, 

1914.  January  to  August 

In  April,  he  gave  evidence  before  the  Royal  Conimission 
on  Venereal  Diseases.  He  laid  stress  on  live  points  : 
(i)  That  death-certificates  ought  to  be  privileged  statements, 
not  shown  to  the  family,  but  sent  direct  to  the  Registrar. 
(2)  That  there  ought  to  be  more  education  of  children  in 
the  facts  of  sex.  (3)  That  there  cjght  to  be  more  education 
of  adults  in  the  facts  of  venereal  disease  ;  this  education 
to  be  given  mostly  by  non-medical  teachers.  (4)  That  the 
venereal  diseases  ought  to  be  made  notifiable  :  the  notifica- 
tion would  be  regarded  as  confidential.  (5)  That  there 
ought  to  be  protection  for  any  doctor  who  should  warn 
persons  against  the  danger  of  infection  from  this  or  that  one 
of  his  patients.  But  Horsley's  evidence  is  only  a  small  part 
of  the  service  which  he  rendered,  in  this  matter,  to  the  public. 
He  and  others  had  been  quietly  working  for  many  years 
to  get  the  Commission  appointed  :  and  the  letter  in  the 
Morning  Post,  which  led  up  to  the  appointment,  was  partly 
his.i 

On  May  28,  he  writes  to  a  friend  : 

People  who  a  year  ago  thought  I  was  cracked  are  coming 
to  see  that  they  too  must  accept  women's  enfranchisement  as 
a  measure  of  vital  and  urgent  importance,  and  that  militancy 
is  a  symptom  of  the  disease-condition  set  up  by  McKcnna's 
stujjidity  in  being  antisuffragist.  ...  I  am  quite  sure  that 
I  did  the  right  thing  with  tlie  Harboro'  constituency.  No, 
it  is  the  temperance  factor  which  is  as  much  or  more 
against  me. 

In  June,  in  Birmingham,  at  the  annual  conference  of  the 

'  As  Mr.  E.  B.  Turner  saiil,  at  a  meeting  held  a  few  days  after  the  news 
of  Horsley's  death — ■'  Twenty  years  ago,  the  light  to  get  the  Kuyal  Com- 
mission on  Venereal  Diseases  Ixjgan  ;  and  it  wius  seen  that  a  man  was 
required  of  forceful  nature,  who  would  give  time,  trouble,  and  energy  ; 
who  wouhl  collect,  collate,  and  bring  forward  the  ma.ss  of  medical  informa- 
tion that  was  needed  to  convince  the  public.  Sir  Victor  threw  himself 
into  the  campaign,  spoke  at  meetings,  and  helped  to  wear  down  the  opjKJSi- 
tion.  Whatever  good  came  from  the  Commissioners'  work,  the  whole 
nation  would  owe  to  Sir  Victor  Horsley  an  enormous  debt  of  gratitude  for 
what  ho  did.' 

O 


210  SIR  VICTOR  ilORSLEY 

National  Council  oi  Trained  Nurses,  he  gave  an  address  on 
'  Nursing  under  the  Insurance  Act '  : 

People  say  '  There  are  not  enough  properly  trained  nurses 
in  the  country.'  I  know  there  are  not.  Now  is  the  oppor- 
tunity for  the  nursing  profession  to  tell  the  public  why 
there  are  not  enough  trained  nurses.  I  do  hope  the  public 
will  read  their  papers,  and  consider  the  points  and  condi- 
tions of  nursing  w'ork.  I  am  convinced  that  the  shortage 
of  fully-trained  nurses  is  due  to  the  fact  that  fewer  persons 
are  entering  the  profession,  and  that  the  chief  reason  for 
this  is  that  the  remuneration  of  nursing,  as  a  skiUed  and 
learned  work,  is  insutlicient.  Secondly,  the  hours  of  nursing 
are  long.  Two  months  ago  we  had  an  interesting  paper 
suggesting  an  eight-hour  shift,  and  showing  that  it  could 
be  successfully  carried  out.  It  is  certain  that  the  hours 
of  working  arc  too  long,  and  the  work  is  often  monotonous. 
Lastly,  we  have  to  recognise  the  competition  of  other  channels 
of  work,  equaUy  or  better  paid,  and  giving  greater  hberty. 

In  Jime,  also,  in  Southsea,  he  spoke  at  the  annual  con- 
ference of  the  International  Abohtionist  Federation.  His 
speech  is  reported  as  follows  : 

He  said  that  prostitution  was  to  a  large  extent  due  to 
drink ;  not  necessarily  drinking  to  excess.  His  personal 
experience  was  supported  by  statistics  from  Sweden,  The 
wage  question  he  also  regarded  as  a  fundamental  one,  and 
at  the  bottom  of  the  problem.  It  had  been  proved  that 
with  low  wages  the  rate  of  prostitution  became  high.  The 
improved  morality  of  the  Army  began  in  1904,  when  increased 
pay  was  given  to  the  soldier.  He  regarded  the  land  question 
as  a  contributory  factor  to  prostitution,  because  the  present 
land  system  had  its  results  in  bad  housing,  overcrowding 
conditions,  slums,  etc.  '  The  discomforts  of  home  drive  a 
girl  on  to  the  streets  for  amusement,  and  sometimes  for  prosti- 
tution.' They  had  5,000,000  people  living  in  slums,  and 
until  they  adopted  a  rational  system  of  land  values  they 
would  never  solve  the  housing  question.  Another  cause 
of  prostitution  was  the  social  position  of  women,  and  the 
theory  of  a  dual  morality — one  for  women,  another  for 
men.  He  held  that  anti-suffrage  views  were  responsible  in 
a  great  measure  for  the  continuance  of  that  idea  of  degrada- 
tion. He  urged  that  what  was  wanted  for  dcahng  with 
this  and  other  problems  was  the  national  co-operation  of 
men  and  women. 

In  July,  he  published  a  short  note  on  a  point  of  general 
surgery,  '  Ha;mostasis  by  application  of  living  tissue.'     The 


FROM  1907  TO  AUGUST  1914  211 

annual  meeting  of  the  British  Medical  Association,  this  year, 
was  in  Aberdeen  :  and  the  University  of  Aberdeen  took 
occasion  to  confer  on  him  the  degree  of  a  Doctor  of  Law. 
He  read  a  paper  on  '  The  reform  of  the  vital  statistics  of  the 
nation  ' — his  old  theme,  the  misuse  of  death-certificates — 
with  a  prophecy  of  the  Ministry  of  Health :  *  The  office  of 
the  Registrar-General  ought  to  be  completely  reconstituted 
as  a  sub-office  of  a  Ministry  of  Public  Health,  which  will 
unite  the  three  existing  and  incoordinate  branches  of  pubhc 
health  work,  namely  the  Local  Government  Board,  the 
Board  of  Education,  and  the  Home  Office.'  He  also  gave  an 
address,  at  a  men's  Sunday  meeting,  on  '  Alcohol  as  a  racial 
poison  '  :  and,  at  a  great  open-air  meeting  in  Castlegate, 
spoke  on  female  suffrage.  From  Aberdeen,  he  and  Lady 
Horsley  went  to  Orkney,  where  he  spoke  in  Kirkwall  on 
female  suffrage.  They  got  back  to  London  in  the  first  week 
of  the  War. 


Professional  Politics 

The  administrative  affairs  of  his  profession,  its  place  in  the 
social  system,  its  influences  on  the  mind  of  the  community, 
were  of  unfailing  interest  to  him  :  they  exercised  his  desire 
to  improve  the  conditions  and  the  rewards  of  general  prac- 
tice, and  to  uphold  the  rights  of  his  less  fortunate  brethren 
against  the  insolence  of  office.  The  education  and  examina- 
tion of  students,  the  penalties  for  wrongdoing,  the  protection 
of  honourable  men  from  slander  or  blackmail,  the  protec- 
tion of  the  public  from  quackery,  the  teaching  of  hygiene 
and  temperance,  the  adjustment  of  the  balance  between 
State-service  and  private  practice,  the  registration  of  nurses, 
the  registration  of  midwives — these  all  appealed  to  him. 
He  had  well-dehned  rules  of  action  :  he  knew  what  he 
wanted,  and  he  was  ingenious  to  plan  assaults  and  to  carry 
them  through.  One  of  his  friends  has  said  that  it  vexed 
hnn,  to  l)e  told  that  he  enjoyed  fighting  :  and  of  course  it 
vexed  him  to  feel  that  a  man  could  think  of  him  as  merely 
quarrelsome,  flying  at  harmless  passers-by  just  for  the  fun 
of  it  :  but  he  was  the  Achilles  of  his  profession — '  Impiger, 
iracundus,  inexorabilis,  acer  ' — and  its  politics  were  never 
dull  to  him.  Only,  his  habit  of  taking  for  weapons  any 
handy  phrases,  not  carefully  weighing  their  offensiveness  or 
reckoning  their  effects,  and  the  rather  dictatorial  air  which 
was  natural  to  him,  delayed  the  success  of  his  plans  :  he 
was  too  ready  to  use  insolence  of  rebuke  against  insolence 
of  office. 

This  readiness  to  find  fault  with  people  in  high  places 
was  reconciled  in  him — he  was  lull  of  vivid  contrasts — with 
unceasing  thoughtfuhiess  for  those  who  neither  were  nor 


PROFESSIONAL  POLITICS  213 

ever  would  be  anywhere  near  the  high  places. *  And,  of 
course,  it  is  not  only  in  professional  politics  that  one  observes 
this  contrast  in  him.  Always,  he  lived  up  to  the  difficult 
saying,  '  All  men  are  equal  in  the  sight  of  God.'  For 
example,  he  rebuked  the  Archbishop  of  York,  for  saying 
something  charitable,  early  in  the  first  year  of  the  War,  of 
the  Kaiser.  He  rebuked  Lord  Morley,  for  half  a  dozen 
words  in  his  Rousseau  :  any  physiologist  might  resent  them, 
without  calUng  Lord  Morley  to  account  for  them.  As  for 
lesser  persons  in  high  places,  he  took  them  to  task  when 
they  needed  it.  Happily,  he  adopted  into  his  life  not  the 
fust  half  only,  but  the  whole  of  the  text,  '  Deposuit  potentes 
de  sede  :   et  exaltavit  humiles.' 

His  love  of  his  profession  was  not  sentimental :  it  was 
clear-sighted,  masterful,  and  creative.  As  he  came  to  be 
on  the  side  of  democracy,  so  he  came  to  regard  his  profes- 
sion as  a  trade-union  :  it  was  of  a  kind  apart,  for  its  members 
did  a  vast  amount  of  work  for  nothing,  nor  could  they  strike. 
None  the  less,  it  was  a  secular  body  of  men  of  busmess, 
whose  object  was  to  earn  a  liveUhood  :  and  many  of  them 
could  not  earn  so  much  as  they  deserved,  but  were  over- 
worked, underpaid,  put-upon,  ill-organised,  and  ill-repre- 
sented. He  longed  for  every  one  of  them  to  have  a  good 
time.  That  is  the  abiding  spirit  of  all  his  action  in  profes- 
sional politics.  The  set  scenes  for  it  were  (i)  the  Medical 
Defence  Union,  (2)  the  General  Medical  Council,  (3)  the  Royal 
College  of  Surgeons,  (4)  the  British  Medical  Association. 

I.    THE   MEDICAL   DEFENCE   UNION 

The  episode  of  the  Folkestone  Church  Congress  in  i8f)2 
was  the  beginning  of  his  representative  work  for  his  pro- 
fissioii.     'i'lie  Medical  Defence  Union  was  founded,  in  i8cS5, 

'  Dr  Alfred  Cox,  Medical  Secretary  of  the  British  Medical  Association, 
who  was  for  many  years  in  close  work  with  Horsley  over  the  Association's 
affairs,  writes  :  '  Tlic  man  who  could  \)C  overl)carinK  «^"'l  even  insolent  to 
his  equals  and  "  superiors  "  was  always  most  considerate  to  smaller  men. 
Nothing  in  his  character  was  more  reniaikalile  to  me  than  the  deferential 
way  in  which  ho  would  listen  to  the  humhlc  workers  in  the  causes  in  which 
he  was  interested,  and  the  way  in  which  ho  would  willinRly  Rivo  way  on 
many  occasions  to  ]>ersonal  cxj>orienco  in  matters  which  he  could  only 
deal  with  theoretically.' 


214  ^IR  VICTOR  MORSLEY 

in  London.  It  was  not  founded  on  the  right  lines  ;  and  at 
tirst  it  failed.  In  1888,  it  was  reconstructed,  in  Birmingham, 
with  Mr.  Lawson  Tait  as  President,  and  was  made  successful. 
Hut  Mr.  Tait's  methods  were  not  approved  by  everybody  : 
and  at  tlie  time  of  the  Church  Congress  he  spoke,  at  a  meet- 
ing of  anti-vivisectionists,  in  a  t(me  which  his  profession 
deeply  resented.^  He  resigned  his  Presidency  ;  and  the 
Medical  Defence  Union  came  back  to  London,  with  Horsley 
as  President.  There  is  a  letter  to  Horsley,  written  a  few 
days  after  the  Folkestone  Church  Congress,  from  one  of  the 
officials  of  the  Medical  Defence  Union  : 

Your  courage  and  able  defence  only  show  us  that  the 
best  interests  of  the  profession  lie  in  your  hands,  and  we  owe 
you  grateful  thanks  for  your  disinterested  conduct.  If 
you  were  elected  President  of  the  Union,  would  you  under- 
take the  duties  ?  I  am  writing  unofficially  of  course  at 
present — at  the  request  of  well-known  men  in  London. 
Your  action  has  won  the  respect  and  gratitude  of  every 
man  I  have  come  across,  and  I  can  only  say  we  honour  you 
for  it. 

Dr.  A.  G.  Bateman,  its  Hon.  Secretary  for  more  than  a 
quarter  of  a  century,  writes  : 

He  threw  himself  heart  and  soul  into  the  work  of  Medical 
Defence,  sparing  neither  himself  nor  the  Executive  in  the 
fulfilment  of  his  duties.  He  not  only  attended  every  Council 
and  Executive  Meeting,  but  gave  many  other  hours  of  his 
valuable  time  to  the  Union. 

He  held  tliat  the  work  of  Medical  Defence  is  threefold, 
concerning  a  medical  man  in  relation  to  his  patients,  to  his 
colleagues,  and  to  tlie  general  public  ;  and  that  it  is  both 
direct  and  indirect.  Direct  defence,  by  an  impersonal  and 
])owerful  association,  was  needed,  because  a  medical  man  is 
peculiarly  exposed  to  blackmail  and  other  methods  of  attack 
from  unscrupulous  people.  It  was  of  the  utmost  importance 
that  his  defence  siiould  be  conducted  by  an  impersonal  body 
like  the  Union  :  it  proved  to  the  public,  the  Court,  and  the 
parties  concerned,  that  the  assailed  practitioner  did   not 


*  His  position  with  regard  to  experiments  on  animals  was  equivocal  : 
for  in  1893,  at  an  important  meetinR  of  his  profession  in  Birmingham  to 
promote  the  founding  of  the  British  Institute  of  Preventive  Medicine  (the 
Lister  Institute),  he  said  that  he  fully  assented  to  the  resolution,  feeling 
that,  while  he  objected  to  a  certain  class  of  surgical  investigations,  bacterio- 
logical experimeoLs  00  aiumaJs  had  proved  of  great  value. 


PROFESSIONAL  POLITICS  215 

stand  alone  but  had  the  support  of  his  fellows.  Horsley 
urged  this  point  very  strongly  ;  and  his  persistent  advocacy 
of  its  importance  brought  a  large  increase  of  members.  In 
many  instances,  the  mere  fact  that  the  Union,  with  Horsley 
at  the  head  of  it,  was  prepared  to  support  and  defend  a 
practitioner  against  litigation,  made  his  assailants  recon- 
sider their  position  and  withdraw  their  attack ;  but  it 
must  be  clearly  understood  that  the  Council  had  a  legal 
right  to  refuse  any  man  whose  conduct  had  been,  in  their 
opinion,  unprofessional  or  improper.  Blackmailing  prac- 
tically ceased  when  the  Union  was  proved  to  be  ready  for 
action. 

Indirect  defence  refers,  inler  alia,  to  conditions  under 
which  a  man  is  injured  not  only  by  disputes  with  other 
practitioners  but  by  competition  of  an  improper  and  un- 
lawful character.  Injurious  competition  may  come  either 
from  his  qualified  colleagues  or  from  unqualified  practi- 
tioners and  quacks. 

While  Horsley  was  President,  a  case  arose  in  which  two 
members  of  the  Union  were  concerned.  It  involved  serious 
issues  :  for  by  an  error  of  the  Executive,  the  case  of  one 
member  was  refused,  and  the  case  of  the  other  was  accepted. 
The  refused  member  took  legal  proceedings  against  the 
President.  It  became  necessary  to  prevent  the  mischief 
from  spreading,  to  the  detriment,  if  not  disruption,  of  the 
Society.  Horsley 's  management  of  this  grave  trouble 
showed  his  masterly  skill  in  tactics  :  the  legal  proceed- 
ings were  kept  within  reasonable  limits  and  brought  to  a 
satisfactory  end ;  he  visited,  with  two  of  the  Society's 
officers,  the  chief  centres  in  the  provinces,  and  held  meet- 
ings at  which  the  cause  of  the  trouble  was  fully  and  clearly 
explained :  and  thus  prevented  the  threatening  disruption. 
His  charm  and  his  diplomacy  at  the  meetings  worked 
wonders  :  and  the  Society,  instead  of  losing  strength,  gained 
it,  and  witii  it  gained  increase  of  the  general  confidence  in 
its  Executive. 

Horsley  always  felt  that  the  defence  of  the  profession 
against  unqualified  practice  was  seriously  handicapped  by 
the  wording  of  the  penal  sections  of  the  Medical  Act,  1858, 
It  was  held  that,  by  these  sections,  medical  practice  was 
not  the  monopoly  of  registered  practitioners  :  that  only 
the  scheduled  medical  titles  were  conserved.  In  other 
words,  any  unqualified  person  could  practise  medicine  with 
impunity,  provided  that  he  did  not  call  himself  by  anv  of 
the  nunu-rous  titles  apjienfled  to  the  Medical  .Act.  Horsley 
strove  in  every  possible  way  to  obtain  amendment  of  the 
Act  :  but  though  he  drafted  or  helped  to  draft  many  Bills, 
no  progress  was  made  in  the  face  of  the  extraordinary  love 
of  quackery  which  is  to  be  found  among  MembeiT;  of  I'arlia- 


2l6  SIR  MCTOR  IIORSLEY 

mcnt  in  both  Houses.  He  urged  in  season  and  out  of  season 
that,  for  the  protection  of  tlie  pubhc,  medical  attendance 
on  the  sick  ought  to  be  restricted  to  quahfied  practitioners  ; 
and  that  there  was  urgent  need  of  legislation,  not  to  create 
a  monopoly,  but  to  protect  the  public.  But  the  opposi- 
tion was  too  strong  :  and  during  his  Presidency,  and  since 
then,  it  has  only  been  possible  to  prosecute  unqualified 
persons  under  section  40  of  the  Act,  which  is  hopelessly 
inadequate. 

In  October  1897  he  had  to  resign  the  Presidency,  on  his 
election  to  the  General  Medical  Council :  but  he  never  lost 
touch  with  the  Union.  Its  work  was  congenial  to  him  : 
and  he  was  ever  ready  to  admit  that  he  had  learned  a  great 
deal  from  the  many  thousands  of  medico-legal  cases  which 
were  dealt  with  during  his  term  of  office.  The  experi- 
ence was  of  value  to  him  on  the  General  Medical  Council, 
in  the  iniquities  of  medical  aid  associations,  the  covering 
of  unqualified  assistants,  and  unqualified  practice. 

His  services  as  an  expert  witness,  on  behalf  of  members 
unjustly  attacked,  were  often  asked  for  and  never  refused  ; 
and  he  would  at  any  time  confer  with  those  who  were  con- 
ducting the  defence.  A  keen  fighter,  he  was  equally  happy 
either  defending  or  attacking.  '  Compromise  '  was  a  word 
not  to  be  found  in  his  dictionary  :  and  '  tactics  '  suited  him 
better  than  '  tact.'  They  who  worked  with  him  soon  realised 
that  time  was  made  for  man,  and  that  '  office  hours  '  had 
no  strict  limit  :  certain  work  had  to  be  done  and  finished 
straight  on  end,  according  to  him. 


2.    THE   GENERAL   MEDICAL   COUNCIL 

In  1896,  at  the  Carlisle  meeting  of  the  British  Medical 
Association,  Horslcy  and  others  had  urged  the  reforni  of 
the  General  Medical  Council :  and  on  October  13,  1897,  he 
was  elected  to  it  as  one  of  the  three  direct  representatives 
chosen  by  the  whole  profession.  He  had  said  very  plainly, 
in  his  electoral  address,  that  the  Council  was  remote  from 
present  needs,  and  of  little  use  to  men  in  practice.  It  had 
shown  itself  indifferent  to  cases  sent  up  to  it  from  the 
Medical  Defence  Union  :  but  that  was  a  small  matter.  The 
serious  grievance  was  in  the  slowness  of  its  ways,  and  the 
difficulty  of  access  to  its  doings.  He  went  to  it,  as  he  let  it 
know,  to  stir  it  up  :  it  was  not  minded  to  be  reformed  at 
short  notice  :  and  he  did  not  at  first  gain  its  approval.    The 


PROFESSIONAL  POLITICS  217 

wo:k  of  the  Medical  Defence  Union,  at  closer  range  and 
with  quicker  results,  had  exactly  suited  him,  for  he  was 
always  intended  by  nature  to  be  in  final  authority — an 
admirable  President,  an  admirable  Chairman — but  he  did 
not  fare  so  well  in  the  givo-and-tnke  of  Committee-meetings. 
It  was  a  great  change  for  him,  from  the  rapid  decisions  of 
the  Medical  Defence  Union,  the  hand-to-hand  encounters 
with  litigants,  the  adventures  in  the  Law  Courts,  to  the 
intricate  and  argumentative  affairs  of  the  General  Medical 
Council,  its  formalities,  deliberations,  and  wearisome  corre- 
spondence with  universities  and  colleges  over  examinations 
and  degrees.  He  offended  by  his  vehemence  ;  and,  it  may 
be,  by  his  annual  '  addresses  to  his  constituency,'  in  which 
he  explained  to  the  profession  at  large  what  the  Council  was 
doing  or  was  leaving  undone.  But,  in  the  long  run,  he  put 
through,  or  helped  to  put  through,  many  of  his  plans. 

One  of  his  colleagues  on  the  Council,  Sir  Charles  S.  Tomes, 
writes  of  him  : 

His  first  public  action  on  the  Council  was  to  raise  the 
question  of  infringement  of  its  members'  rights  to  inspect 
documents  preserved  in  the  Council's  archives :  he  had 
been  denied  access,  by  the  President,  to  documents  bear- 
ing upon  recent  decisions.  Thus,  his  first  action  brought 
liim  into  direct  confiict  with  the  President  :  and  his  motion 
was  defeated.  But  in  the  next  session,  other  direct  repre- 
sentatives moved  that  members  wanting  to  inspect  docu- 
ments should  obtain  leave  from  the  Council  or  from  its 
Executive  Committee  or,  if  neither  were  in  session,  from 
the  President  :  but  only  the  Council  should  give  leave 
for  inspection  of  documents  relating  to  penal  cases,  these 
hoAup,  confidential.  This  compromise  was  agreed  to,  and 
Ilorsley  at  once  obtained  leave  to  inspect  the  documents 
relating  to  some  recent  penal  cases. 

About  the  same  time,  he  raised  a  question  as  to  the  con- 
duct and  expenses  of  the  legal  business  of  the  Council  :  he 
failed  to  carry  his  motion  :  later,  he  returned  to  the  charge, 
and  called  attention  to  the  fact  that  neither  the  solicitor 
nor  the  standing  rounsel  (legal  assessor)  had  ever  received 
any  formal  appointment. 

As  one  reads  the  Minutes  of  the  Counril,  dnring  ITorsley's 
early  days  of  membership,  one  cannot  fail  to  see  tliat  his 
proposals  were  very  often  flefcatcd,  and  later,  and  perhaps 
in  fliffcrent  terms,  were  effective.  The  explanation  is  not 
far  to  seek.     Feeling  strongly  on  them,  and  often  having 


2i8  SIR  VICTOR  IIORSLEY 

a  very  strong  case,  he  was  not  careful  to  present  it  in  a 
non-personal  form  :  on  the  contrary,  he  sought  to  fasten 
blame  on  individuals,  and  thus  provoked  antagocism. 
This  was  a  defect  of  his  qualities.  Directness,  earnest- 
ness of  purpose,  dislike  of  compromise,  and  some  inability 
to  recognise  that  when  he  was  convinced  of  being  in  the 
right,  others  migiit  differ  from  him  without  being  actuated 
by  wrong  motives,  combined  to  give  a  cast  to  his  methods. 
He  had  some  consciousness  of  this  habit  of  mind,  and  did 
not  in  the  least  object  to  being  chaffed  with  such  enquiries 
as  '  Who  is  your  latest  scoundrel  ?  ' 

The  Use  of  Titles. — A  case  wliich  greatly  interested  him. 
and  had  much  to  do  with  his  attitude  toward  the  Council, 
was  that  of  Mr. ,  a  licentiate  of  the  Society  of  Apothe- 
caries and  an  M.D.  of  Philadelphia.  He  held  no  British 
quahfication  except  the  L.S.A.  He  styled  himself  both 
M.D.  and  '  Physician  and  Surgeon  '  :  but  later  he  seems 
to  have  abandoned  the  use  of  the  M.D.  The  Penal  Cases 
Committee  recommended  that  proceedings  be  taken  against 
him  :  and  he  was  convicted  before  a  bench  of  magistrates 
on  the  wrongful  use  of  the  title  of  '  physician.'  The  charge 
of  wrongful  use  of  the  title  of  '  surgeon  '  was  not  pressed 
after  the  one  conviction.  An  appeal  was  lodged  :  he  died 
before  it  was  heard :  finally,  the  conviction  was  quashed : 
the  Court  held  that  though  he  had  no  right  to  the  title  of 
'  physician,'  or  '  pliysician  and  surgeon,'  he  had  not  used  these 
titles  '  wilfully  and  falsely.'  The  Council  were  behind  this 
action  :  but  the  nominal  complainant  was  a  solicitor's 
clerk.  Horsley  thought  that  the  prosecution  was  alto- 
gether improper  and  should  never  have  been  undertaken  : 
though  it  had  been  intended,  more  or  less,  to  be  merely 
a  '  test-case.'  His  interference  was  between  the  convic- 
tion and  the  hearing  of  the  appeal.  It  led  to  some  very 
hot  discussions  :  one  member  of  the  Council  went  so  far 
as  to  call  him  a  Yahoo  :  his  motion  against  the  Penal  Cases 
Committee  was  defeated  :  but  the  attention  called  to  the 
whole  affair  was  not  without  effect. 

The  Midtc'ives  Bill. — About  this  time,  he  was  appointed 
a  member  of  the  Conference  on  the  proposed  Midwives  Bill, 
which  became  law  in  1902  :  he  took  great  interest  in  this 
work,  and  in  the  relations  finally  established  between  the 
Central  Midwives  Board  and  the  Council. 

Personal  ion. — Several  instances  of  the  personation,  by 
unqualified  men.  of  deceased  or  far-away  practitioners, 
came  to  the  knowledge  of  the  Council.  The  law  on  this 
matter  was  peculiar.  Personation  was  not,  of  itself,  a  legal 
offence,  though  it  might  easily  induce  the  pretender  to  commit 
some  offence.  The  Council  therefore  desired  to  make  per- 
sonation  as  difficult   as    possible,   and   a   Committee    was 


PROFESSIONAL  POLITICS  219 

appointed,  witli  Horsley  as  Chairman,  in  1899.  Questions 
of  law  had  to  be  decided  :  it  was  not  till  1902  that  the  Com- 
mittee made  its  recommendations.  These  mostly  were 
adopted,  and  have  been  found  very  useful. 

Licensing  bodies  and  their  examinations. — It  appeared  to 
the  Council  that  there  was  no  agreement  among  the  various 
licensing  bodies  as  to  the  exemption  from  portions  of  their 
examinations  to  be  granted  to  students  who  had  passed 
in  these  subjects  elsewhere.  Horsley  moved  that  tlie  Council 
should  be  furnished  with  lists  of  these  exemptions :  and  this 
is  still  done  annually.  It  was  found  that  some  bodies  gave 
no  exemption,  and  others  gave  a  good  deal,  but  not  in  their 
final  examinations.  He  raised  a  furtlier  question  as  to 
the  examinations  of  the  Conjoint  Board  (England)  in  the 
preliminary  scientific  subjects,  and  their  recognition  of 
teaching  institutions  not  yet  recognised  by  the  Council. 
He  was  of  opinion  that  the  requirements  in  chemistry  were 
insuflicient — he  included  those  of  the  Conjoint  Board  of 
Scotland — and  that  the  matter  ought  to  be  reported  to  the 
Privy  CouncU. 

Aynendment  of  Companies  Acts. — About  this  time,  a 
Companies  Acts  Amendment  Bill  was  before  Parhament  : 
and  a  small  Committee  (the  President,  Horsley,  and  myself) 
were  empowered  to  ask  the  Government  to  insert  a  clause 
preventing  the  registration  of  Companies  to  carry  on  medical, 
surgical,  and  dental  work.  One  way  of  evading  the  pro- 
visions of  the  Acts  was  by  incorporation  into  a  Limited 
Company,  generally  of  the  one-man  type,  with  the  required 
number  of  signatories  made  up  of  men  of  straw.  The  Com- 
mittee, having  waited  without  success  upon  the  President 
of  the  Board  of  Trade,  drafted  a  memorial  to  the  Lord 
Chancellor,  which  was  favourably  received.  Amendments 
were  introduced,  in  the  House  of  Lords,  and  were  thrown 
out  in  the  Commons.  This  question  of  evasion  by  incor- 
poration came  up  again  and  again,  and  Horsley  always 
took  an  active  part.  But  little  has  been  done,  save  that 
the  registrars  of  Joint  Stock  Companies  now  refuse  to  register 
titles  which  too  clearly  arc  against  the  spirit,  if  not  against 
the  letter,  of  the  law. 

Finance  of  the  Council. — The  Act  constituting  the  Council 
(1858)  laid  down  a  very  definite  j)lan  for  the  aclniinistration 
of  the  finances  of  the  Council,  and  of  its  Bran(  h  Councils  : 
hut  this  plan  involved  a  sort  of  battlcdore-and-shuttlecock 
transference  of  monii'S  from  one  account  to  the  others  and 
back  again,  which  was  hard  to  follow.  Horsley  moved 
for  a  Committee  to  simplify  these  matters,  and  was  appointed 
a  member  of  it.  The  expenditure  of  the  Council  and  its 
Branches  largely  exceeded  the  joint  income  ;  and  the  Com- 
mittee had  to  consider  possible  economies,  as  well  as  simpli- 


220  SIR  VICTOR  IIORSLEY 

fication  of  accounts.  It  was  not  thought  desirable  to  try 
for  an  Amending  Bill  in  Parliament  :  but  expert  advice 
was  taken,  and  some  improvements  were  made  in  the  pre- 
sentation of  accounts. 

Tluis,  it  will  be  seen  that  Horsley,  as  might  have  been 
expected,  took  a  very  active  and  useful  part  in  the  work 
of  the  Council,  and  after  his  initial  stormy  period  was  largely 
concerned  with  less  controversial  subjects,  and  was  more 
uniformly  successful  in  carrying  liis  points. 

At  the  end  of  his  first  term  of  office  of  five  years,  he  was 
re-elected,  by  a  large  majority.  Just  before  the  end  of 
his  second  term,  he  resigned,  that  he  might  save  the  Council 
from  the  expense  and  trouble  of  a  separate  single  election. 
His  reason  for  not  desiring  a  third  term  of  office  was.  that 
he  considered  that  for  the  most  part  the  things  which  he 
desired  to  do  on  the  Council  had  been  accomplished,  and 
that  ho  now  could  be  more  useful  elsewhere. 


3.    THE   ROYAL   COLLEGE   OF   SURGEONS 

The  Royal  College  of  Surgeons  of  London  was  founded  on 
what  was  left,  in  the  eighteenth  century,  of  the  old  Guilds. 
In  1743,  the  union  of  the  Barbers'  Company  and  the  Surgeons' 
Company  was  dissolved,  and  the  Corporation  of  Surgeons 
of  London  was  instituted.  Near  the  end  of  the  eighteenth 
century,  the  Corporation  of  Surgeons  was  dissolved,  or  was 
alleged  to  have  been  dissolved  :  and  in  1800  it  was  rein- 
stated or  reconstituted  by  a  Charter,  under  the  title  of  the 
Royal  College  of  Surgeons  in  London.  The  Fellowship  of 
the  College  was  not  instituted  till  1843.  By  the  Charter  of 
1843,  the  right  of  serving  on  the  Council  of  the  College  was 
given  to  F(^ll()ws  only.  Members  have  no  place  on  the 
Council,  and  no  voice  in  the  election  of  the  Council.  In  1884, 
the  reception  of  the  Erasmus  Wilson  bequest  made  it  neces- 
sary to  apply  for  a  new  Charter,  as  the  College  wjls  not 
allowed  to  hold  property  of  a  yearly  value  above  ;f20oo. 
At  this  time,  two  associations  were  formed,  one  of  Fellows, 
the  other  of  Members  :  both  of  them  were  in  favour  of 
making  the  management  of  the  College  more  widely  repre- 
sentative :  but  the  new  Charter,  granted  in  1888,  left  things 
as  they  were.  In  i88q,  the  Association  of  Members  un- 
wisely attempted  to  hold  a  meeting  of  their  own  at  the 


PROFESSIONAL  POLITICS  221 

College,  against  the  will  of  the  Council ;  and  found  them- 
selves locked  out.  Over  this  defeat,  they  went  to  law  with 
a  '  test-case,'  Steele  v.  Savory  ;  it  was  decided  against  them 
in  1892  :  the  failure  and  the  heavy  cost  of  this  lawsuit 
killed  the  Association  :  but  in  1894  it  was  formed  again, 
as  the  Society  of  Members.  Thus  there  are  two  bodies 
outside  the  Council  as  its  critics — the  Association  of  Fellows, 
and  the  Society  of  Members.  Horsley  belonged  to  both  of 
them.  In  1896,  the  Committee  of  the  Association  of  Fellows 
asked  him  to  stand  for  the  Council,  and  promised  to  support 
him  :   but  he  did  not  accept  this  invitation. 

For  thirty  years,  1884-1914,  at  every  annual  meeting  of 
the  College,  certain  Members  have  protested  against  the 
exclusion  of  Members  from  a  place  on  the  Council  and  a 
vote  for  the  Council,  and  have  asked  for  direct  representa- 
tion. '  Resolutions  to  this  effect,'  says  one  of  them,  *  have 
been  carried  by  large  majorities,  and  often  without  a  single 
vote  recorded  in  opposition.'  Nothing  comes  of  these 
resolutions  :  the  Council  receives  them  with  impassive 
dignity :  hke  the  Senate,  who  remained  silent  on  their  chairs 
of  oflice  when  the  Gauls  broke  into  the  Senate-house.  For 
one  who  has  never  taken  part  in  these  affairs,  it  is  hard  to 
see  why  the  Members  should  not  have  what  some  of  them 
so  greatly  desire.  The  Council,  about  1904,  decided  '  That 
as  the  Members  of  this  Council  represent  the  body-cor- 
porate of  the  Royal  College,  and  consequently  its  Members 
as  well  as  its  Fellows,  it  is  the  opinion  of  this  Council  that 
no  further  representation  is  desirable.'  Doubtless  the 
Council  was  afraid  of  entanglement  in  controvei-sies  which 
would  hinder  and  impair  its  regular  work. 

In  1912,  and  again  in  1914,  Horsley  moved  the  invariable 
old  resolution — word  for  word  the  same,  each  time — on 
behalf  of  the  Society  of  Members,  at  the  Annual  Meeting 
of  the  Collfge.  In  191 2,  one  of  the  Council  answtMcd  him, 
denying  that  the  Council  '  considered  the  Mcmbci-s  unlit 
to  sit  with  them,'  and  saying  that 

The  reason  why  they  did  not  agree  to  admit  Members 
into  the  Council  was  because  the  Council  of  the  ("olU^go  was 
not  a  legislative   body.     The   mutters  with   which   it   had 


222  SIR  VICTOR  HORSLEY 

more  especially  to  concern  itself  were  the  care  of  the  most 
valuable  museum  of  its  kind  in  the  world,  the  care  of  a 
library  which  deserved  the  high  reputation  it  held,  and  the 
inspection  and  conduct  of  what  he  maintained  were  the 
most  important  and  the  finest  examinations  in  surgery. 
He  did  not  think  that  the  Council  would  be  better  qualified 
to  deal  with  these  matters  if  Members  were  elected  on  it. 
The  next  reason  was  that  an  election  in  which  all  the  Members 
of  the  College,  who  were  scattered  all  over  the  world,  took 
part,  would  be  very  costly,  difficult,  and  he  thought  im- 
practicable. In  matters  affecting  the  profession,  the 
Members  had  the  British  Medical  Association,  which  had 
proved  itself  to  be  admirably  fitted  to  safeguard  the  inte- 
rests of  members  of  the  profession. 


4.   THE   BRITISH   MEDICAL  ASSOCIATION 

The  affairs  of  the  Medical  Defence  Union,  the  General 
Medical  Comicil,  and  the  Royal  College  of  Surgeons,  were 
not  permanent  in  Horsley's  life  ;  he  came  to  them,  followed 
them,  and  went  on  from  them  :  but  the  affairs  of  the 
British  Medical  Association  are  continuous  with  him,  and 
he  is  never  away  from  them.  He  set  himself  to  help  to 
make  it  what  it  is  now,  the  Doctors'  Union,  powerful  and 
effective  and  well-organised  on  modem  lines.  He  wrote  in 
its  Journal,  took  a  chief  part  in  its  Annual  Meetings,  was 
one  of  the  founders  of  its  new  Constitution,  served  on  its 
Council  and  Committees,  was  Chairman  of  its  Meetings  of 
Representatives,  and  Chairman  of  the  Marylebonc  Division 
of  its  Metropolitan  Counties  Branch.  He  worked,  for  it  and 
through  it,  along  every  possible  way  of  politics.  To  him, 
it  stood  for  the  resistance  of  his  profession  against  auto- 
cracy and  bureaucracy  ;  he  looked  for  its  strength  to  tell 
on  the  nation,  the  Government,  Parliamentary  Committees, 
Fri«;ndly  Societies,  and  pubhc  institutions  of  education  and 
of  health  ;  it  was  '  democratic,'  in  touch  with  the  present, 
not  bound  by  traditions  ;  it  could  do  what  the  Royal 
Colleges  and  the  General  Medical  Council  were  not  doing  ; 
it  could  make  people  hear  what  it  said  to  them.  As  he 
wrote  in  1901,  '  It  is  in  my  opinion  ridiculous,  trying  to 
concihate  the  old  men  at  the  head  of  the  G.M.C.  They 
must  be  crushed  or  driven  to  do  the  right  thing,  and  if  we 


PROFESSIONAL  POLl  1 ICS  223 

can  only  organise  the  B.M.A.  successfully,  we  shall  do  the 
rest  easily.'  He  had  constantly  in  liis  mind  the  power 
which  the  Association  might  attain  on  these  lines,  as  the 
one  great  intermediary  between  the  State  and  his  profes- 
sion, the  one  system  m  which  the  doctors  would  be  united 
to  defend  themselves  from  injustice,  to  provide  a  better 
service  for  the  nation,  and  to  enforce  proper  rates  of  pay- 
ment of  their  work. 

Dr.  Alfred  Cox,  Medical  Secretary,  has  written  of  this 
factor  of  Horsley's  hfe  : 

More  than  any  other  man  he  made  the  demand  for  the 
reconstitution  ot  tlie  Association  on  democratic  lines  ;  lor 
he  was  the  chief  inspiration  as  well  as  the  leader  of  those 
who  called  together  the  Manchester  Conference  in  1900, 
and  afterwards  approached  the  Council  of  the  Association, 
at  Ipswich,  witli  tiie  proposals  which  led  it  to  set  up  the 
Constitution  Committee. 

...  It  was  natural  that  Horsley  should  become  the 
first  Chairman  of  Representative  Meetings.  He  held  ofiice 
from  1903  to  1906  ;  and  I  beheve  he  was  as  proud  of  that 
ofhce,  and  all  tliat  it  meant  in  providing  opportunities  for 
moulding  the  organisation  of  the  profession,  as  of  any  lionour 
that  was  ever  conferred  on  him :  for  he  had  a  great  idea 
of  the  dignity  and  importance  of  the  Association,  and  of 
the  great  responsibility  of  its  ciiief  executive  officers.  He 
contmued  to  be  a  member  of  the  Representative  Meeting 
until  1912,  and  was  as  able  and  helpful  as  a  member  as 
he  had  been  as  Chairman. 

He  filled  nearly  every  post  in  the  Association  except  tliat 
of  President  and  Chairman  of  Council.  He  was  a  niLinbcr 
of  Council  from  1900  to  1912,  and  was  chairman  of  many 
committees.  His  chief  Association  work  was  done  in  con- 
nection witli  tlie  Organisation  Committee,  where  he  took  a 
very  active  and  prominent  part  in  drafting  tlie  Articles 
and  By-laws,  and  in  the  ap])lication  for  a  Royid  Charter  : 
and  on  the  Medico-l'olitical  Committee.  On  the  latter,  he 
took  the  leading  part  in  forming  the  policy  of  the  Associa- 
tion in  regard  to  reform  of  Coroners'  Law  and  Death  Regis- 
tration, Medical  Inspection  and  Treatment  of  School  Cliildren, 
Amendment  (A  Medical  Acts,  the  constitution  of  a  Mini.sliy 
of  Public  Health,  State  Registration  of  Nurses,  and  suppres- 
sion of  unqualified  practice  and  quack  advertisements.* 


*  How  hard  he  worked,  is  bhown  by  the  mass  ot  his  corrcsiKjinlencc, 
notes  for  addresses,  minutes  of  mocUngs,  rcixjrls,  iiud  press-cut Ungu. 
Tho  work  (or  the  reform  ol  Loroours'  Law,  which  began  with  tlie  atlroata 


224  ^IR  VICTOR  UORSLEY 

...  It  will  help  some  readers  to  realise  the  kind  of  man 
he  was,  to  recall  his  action  in  regard  to  a  presentation  the 
Representatives  proposed  to  make  to  him  when  he  left 
the  Chair.  A  considerable  sum  of  money  was  collected  by 
Dr.  W.  Douglas,  and  a  handsome  piece  of  plate  bought, 
before  Horsley  heard  of  it.  He  at  once  informed  Dr.  Douglas 
that  he  would  rather  the  presentation  were  not  made,  much  as 
he  valued  the  feeling  that  inspired  it.  His  reasons  were 
very  characteristic.  First,  he  said,  he  had  already  been 
thanked  very  generously  for  his  work  in  the  Chair,  and 
secondly,  he  had  ail  his  life  held  the  view  that  personal  pre- 
sentations should  not  be  made  for  pubhc  service,  except 
by  the  State  — '  Work,  whether  pohtical  or  scientific,  if 
done  in  the  interests  of  the  profession,  brings  with  it  not 
only  the  ample  satisfaction  of  having  contributed  to  social 
progress,  but  also  earns  constantly  recurring  grateful  acknow- 
ledgment from  those  who  happen  to  more  directly  benefit 
by  what  has  been  attained.' 

.  .  .  He,  a  consultant  of  the  consultants,  was  able  to  under- 
stand and  sympathise  with  the  difficulties  of  the  general 
practitioner  in  a  way  that  was  all  the  more  effective  because 
taken  from  a  detached  point  of  view  :  and  his  labours  on 
the  Contract  Practice  Sub-committee  left  him  with  a  deep 
conviction  of  the  need  to  improve  the  economic  position 
of  the  general  practitioner,  particularly  in  the  poorer  districts. 

That  is  the  meaning  of  his  fight  for  the  Insurance  Act. 
All  his  work,  year  in  year  out,  had  made  it  clear  to  him 
that  the  Act,  though  it  must  have  its  faults,  would  provide 

put  on  the  doctors  by  the  Coroner  for  South-West  London,  took  three 
years,  1903-1906,  and  came  to  nothing,  or  next  to  nothing  :  the  work  for 
the  medical  care  of  school  children,  the  estabhshment  of  school  dental 
chnics,  and  the  teacliing  of  hygiene  and  temperance  in  schools,  took  tnany 
more  than  three  years  :  the  registration  of  nurses  in  England  occupied 
him  even  in  Mesopotamia  ;  he  writes  to  Dr.  Alfred  Cox  on  May  15,  191O  ; 
he  is  angry  over  the  new  College  of  Nursing,  and  says  unkind  things  of 
its  supporters  :   '  I  have  just  received  the  report  of  the  Conference  between 

and  the  Kegistrationisls.     It  is  very  dillicult  out  here  some  three 

hundred  miles  up  the  Tigris  on  a  burning  mud  Hat  in  the  middle  of  cholera, 
dysentery,  diarrhoea,  etc.  etc.  etc.,  to  judge  exacUy  what  is  being  done 
at  home,  but  it  is  quite  clear  that  all  the  old  enemies  of  the  B.M.A.  are 

behind ,  and  pushing  his  nasty  College  for  all  they  are  worth.     It  seems 

to  me  that  it  being  only  a  manccuvre  to  push  off  Registration,  the  B.M.A. 
ought  to  support  Chappie  and  his  Bill  more  actively.  Also  that  our 
present  representatives  on  the  Central  Committee  to  run  the  Bill  must 
do  much  more  to  fight  tliis  vile  private  hole-in-the-corner  arrangement. 
Considering  that  we  have  been  working  for  twenty-live  years,  it  is  a  little 
too  much  to  see  the  whole  thing  jockeyed.  .  .  .  The  idea  of  starting  a 
College,  not  a  truly  e<lucaUonal  body,  but  the  sham  archaic  examinational 
institute  for  private  registration  that  we  have  suffered  from  so  bitterly 
all  these  years,  is  so  like  the  enemies  of  liberty.  ...  It  is  very  annoying 
bctug  in  all  this  chaos  of  folly  and  not  able  to  help  at  home' 


PROFESSIONAL  POLITICS  225 

not  only  better  service  for  the  insured,  but  more  favourable 
conditions  for  men  overworked  and  imderpaid  in  general 
practice.  Having  this  invincible  faith,  he  stood  up  against 
a  great  outpouring  of  ill-will  and  abuse  from  many  of  those 
whom  he  was  working  for. 

It  was  in  June,  1911,  that  the  British  Medical  Association, 
on  behalf  of  the  profession,  finally  stated  the  '  six  cardinal 
points  '  which  it  was  determined  to  obtain  : 

1.  An  income  limit  of  £2  a  week  for  those  entitled  to 
medical  benefit. 

2.  Free  choice  of  doctor  by  patient,  subject  to  consent  of 
doctor  to  act. 

3.  Medical  and  maternity  benefits  to  be  administered  by 
local  Health  Committees,  and  not  by  friendly  societies. 

4.  The  method  of  remuneration  of  medical  practitioners 
adopted  by  each  local  Health  Committee  to  be  according  to 
the  preference  of  the  majority  of  the  Medical  Profession  of 
the  district  of  that  Committee. 

5.  Medical  remuneration  to  be  what  the  Profession  con- 
siders adequate,  having  due  regard  to  the  duties  to  be  per- 
formed and  other  conditions  of  service. 

6.  Adequate  medical  representation  among  the  Insurance 
Commissioners  in  the  Central  Advisory  Committee  and  in 
the  local  Health  Committees,  and  statutory  recognition  of 
a  local  Medical  Committee  representative  of  the  profes- 
sion in  the  district  of  each  Health  Committee. 

A  few  days  later,  the  British  Medical  Association  sent 
out  the  '  pledge  '  which  was  signed  by  the  very  great  majority 
of  the  profession  : 

I,  the  undersigned,  hereby  undertake  that  in  the  event 
of  the  National  Insurance  Bill  becoming  law,  I  will  not 
enter  into  any  agreement  for  giving  medical  attendance 
and  treatment  to  persons  insured  under  the  Bill,  except- 
ing such  as  shall  be  satisfactory  to  the  medical  profession 
and  in  accordance  with  the  declared  policy  of  the  British 
Medical  Association  ;  and  that  I  will  enter  into  such  agree- 
ment only  through  a  local  Medical  Committee,  representa- 
tive of  the  medical  profession  in  tlie  district  in  whirh  I 
practise,  and  will  not  entrr  into  any  individual  or  separate 
agreement  with  any  approved  Society  or  other  body  for 
the  treatment  of  such  persons. 

On  November  23,  at  a  Special  Meeting  of  Reprosmtatives, 
it  was  decided  that  the  Association  should  hold  to  tfie  six 
cardinal  points. 

P 


226  SIR  VICTOR  HORSLEY 

On  November  30,  the  Prime  Minister's  private  secretary 
wrote  to  Mr.  Smith  Whitaker,  the  Medical  Secretary  of  the 
Association,  offering  him  the  position  of  Deputy-Chairman 
of  the  Commission  under  the  Act.  On  December  2,  the 
Council  of  the  Association  discussed  this  offer.  Horsley 
said  that  '  the  real  question  before  them  was,  Would  they 
be  acting  in  the  best  interests  of  the  profession,  if  they  gave 
permission  to  Mr.  Smith  Whitaker  to  accept  it  ?  He 
beheved  that  they  would,  and  that  their  action  could  be 
justified  completely,  at  any  meeting  of  the  profession,  by 
the  simple  statement  that  the  Bill  would  be  passed  in  spite 
of  the  profession.'  It  was  decided,  by  38  votes  to  3,  that 
Mr.  Smith  Whitaker  was  free  to  accept  the  offer.  At 
the  same  time,  a  memorandum,  signed  by  the  Chairman 
of  the  Representative  Meetings  and  the  Chairman  of  the 
Council,  was  sent  to  the  Members  of  the  Association.  It 
went  over  the  six  cardinal  points,  and  the  pledge  ;  and  it 
advised  the  profession  to  be  content  with  what  it  had 
gained  : 

The  Insurance  Bill  will  probably  become  law  within  the 
next  fortnight,  and  the  Association  and  the  profession 
have  to  consider  their  future  action  towards  it. 

The  poUcy  of  the  Association  as  expressed  in  the  above 
stated  six  cardinal  principles  is  absolutely  unchanged. 

The  Bill  by  the  efforts  of  the  Association  has  now  been 
so  amended  that  there  is  no  legal  barrier  against  the  profes- 
sion securing  the  fulfihnent  of  its  entire  policy. 

The  following  principles  of  the  Association  have  been 
incorporated  in  the  Bill  as  it  has  now  left  the  House  of 
Commons — namely,  the  free  choice  of  doctor ;  the  adminis- 
tration of  medical  and  sanatorium  benefits  by  the  local 
Health  Committee  ;  the  representation  of  the  profession 
on  all  the  administrative  bodies  established  under  the  Act ; 
the  statutory  nxognition  of  a  committee  of  the  medical 
profession  in  each  district. 

In  addition,  the  essential  principle  of  a  wage  limit  is 
recognised  by  Clause  15  (3)  in  the  Bill,  the  precise  amount 
being  fixed  by  the  profession  in  each  district  in  negotiation 
with  the  local  Health  Committee. 

The  remaining  principles  of  the  pohcy  of  the  Associa- 
tion not  dealt  with  under  the  Bill  are  the  rate  and  method 
of  remuneration,  and  the  amount  of  the  wage  Umit.  The 
first  of  these — the  most  essential  of  the  principles  of  the 


PROFESSIONAL  POLITICS  227 

Association — the  Representative  Rod}'  decided  should  be 
settled  by  agreement  between  the  members  of  the  profes- 
sion in  each  district  and  the  local  Health  Committee.  As 
regards  the  second,  it  decided  that  this  also,  if  not  embodied 
in  the  Bill,  should  be  fixed  by  local  negotiation. 

On  December  12,  Horsley  spoke  at  a  Branch  Meeting  of 
the  Association  ;  he  defended  the  appointment  of  Mr.  Smith 
Whitaker :  '  After  all,  the  Insurance  Bill  was  going  through 
over  the  heads  of  the  profession.  When  they  came  to  the 
real  fight  in  the  Divisions  of  the  Association,  they  would 
have  a  good  friend  on  the  Central  Body.  The  Council  had 
had  to  make  the  best  of  a  bad  situation.'  On  December  16, 
the  Act  received  the  Royal  Assent.  On  December  19,  came 
the  disastrous  '  mass  meeting '  at  Queen's  Hall ;  it  did  no 
good,  and  it  degraded  the  profession  in  the  eyes  of  the 
pubhc.  Horsley  was  not  on  the  platform,  but  in  the  body 
of  the  hall.  A  resolution  was  moved  and  seconded,  '  That 
this  mass  meeting  of  the  medical  profession  is  of  opinion 
that  the  six  cardinal  points  originally  formulated  by  the 
British  Medical  Association  are  not  guaranteed  by  the  pro- 
visions of  the  Insurance  Act  in  a  manner  which  satisfies  the 
profession.'  He  rose  to  speak,  and  was  hissed  and  shouted 
at :  he  was  invited  on  the  platform,  and  stood  there,  and 
was  howled  down.  He  bore  it  well :  he  was  writing  his 
letters  at  home,  half  an  hour  later,  as  if  nothing  had  happened. 
Finally,  came  the  threat  that  if  the  doctors  would  not  work 
the  Act,  men  would  be  found,  somehow,  to  take  their  place  : 
and  the  miserable  day  when  the  newspapers  got  out  their 
sensational  posters.  The  Doctors  Brought  to  Heel,  Stampede 
of  the  Doctors — that  sort  of  thing. 

It  is  to  be  noted,  that  he  was  not  a  member  of  the  State 
Sickness  Insurance  Committee,  which  had  formulated  the 
Association's  policy  :  and  that  he  had  only  thrown  in  his 
lot  w ith  his  colleagues  on  the  Council,  and  with  the  Divisional 
Representatives.  But  men  who  think  them.selves  betrayed 
must  find  somebody  to  call  a  traitor  ;  and  he,  with  his 
imperious  self-assertion,  his  flashes  of  insolence,  his  loader- 
ship  in  practice,  his  name  in  public  life,  was  just  wliat  thoy 
wanted.     Long  after  the  passing  of  the  Act,  their  ill-wiU 


228  SIR  VICTOR  HORSLEY 

pursued  him,  and  a  lot  of  nonsense  was  put  about — he  was 
playing  to  the  gallery,  he  was  hoping  for  a  peerage,  he  was 
in  secret  understanding  with  the  Chancellor  of  the  Exchequer 
— to  whom  he  never  had  spoken  a  word,  except  that  he  was 
introduced  to  him  on  a  platform  somewhere.  But  the  irony 
of  it :  that  he  should  be  denounced  by  the  men  whom  he 
was  helping,  and  that  he  who  was  averse  from  all  compro- 
mise should  be  the  victim  of  compromise.  But  his  profes- 
sion was  not  enough  of  a  trade-union  to  fight  and  beat  the 
Government  over  a  question  of  remuneration,  nor  ever  will 
be,  nor  ever  was  intended  to  be,  for  it  cannot  strike  :  it  will 
always,  at  the  last,  subordinate  its  pohtics  to  its  ideals. 

He  writes  from  Orkney,  January  6,  1912,  to  Dr.  Otto 
May,  one  of  the  many  who  were  furious  over  the  disgrace 
of  the  mass  meeting  : 

The  United  Household  is  very  much  pleased  with  your 
epistle  and  its  frank  criticisms  of  our  vocabularial  Conserva- 
tive friends.  It  is  a  great  pity  that  I  am  stiU  a  member  of 
the  Council  and  cannot  write  to  the  Times  to  show  up  these 
silly  idiots,  who  I  see  are  now  starting  a  third — or  is  it  fourth  ? 
— association.  It  really  has  a  comic  side,  although  to  see 
our  trade-union  in  the  hands  of  such  riotous  folk  is  enough 
to  make  the  gods  weep.  I  do  not  yet  see  the  limits  of  their 
'  influence,'  and  cannot  yet  gauge  the  loss  of  prestige  which 
we  shall  suffer  as  a  profession  '  operating  '  human  affairs. 

At  the  end  of  1912,  he  writes  to  a  grateful  patient,  thank- 
ing her  for  a  Christmas  gift,  a  silk  necktie  : 

Not  having  ready  at  hand  an  adequate  stock  of  adjec- 
tives to  describe  correctly  the  exquisite  new  line  in  ties  you 
sent  me,  I  paused  for  breath.  My  efforts  at  recovery  were 
interrupted  by  the  now  unfortunately  successful  attempts 
of  our  Tory  friends  who  run  the  B.M.A.  to  commit  suicide. 
As  they  are  all  Tariff  Rcfomicrs,  poor  things,  they  naturally 
cannot  see  far  in  front  of  their  noses,  and  consequently 
they  resolved  on  Monday  {a)  to  violate  our  six  Cardinal 
Points  and  pledge,  (6)  negotiate  with  the  insured  persons, 
ignoring  the  Government. 

Clearly  they  lived  in  a  lotus  atmosphere,  the  world  forget- 
ting, for  as  a  matter  of  fact  the  insured  persons  have  no 
spare  cash,  and  the  Government  was  to  provide  the  funds  ! 
Can  you  imagine  182  Bonar  Laws  in  one  room  talking  such 


PROFESSIONAL  POLITICS  229 

drivel !     However,  there  we  are.     My  only  joy  is  to  gaze 
upon  your  present  with  admiration.* 

He  remained  on  the  Association's  Sub-committee  for 
the  Medical  Inspection  of  School  Children  ;  and  gave  help 
over  this  or  that  point  of  affairs,  when  he  was  asked.  But 
his  faith  in  its  Council  had  been  injured  past  repair.  Indeed, 
if  it  comes  to  talking  of  '  the  Great  Betrayal,'  as  it  was  called 
in  December  1911,  we  might  say  that  he  had  been  not  the 
traitor  but  the  betrayed. 

In  1913,  he  was  still  at  work  over  the  tangle  of  difficulties 
involved  in  the  Act.  He  writes  to  Dr.  Mary  Sturge  of 
Birmingham,  February  10,  1913  : 

I  don't  believe  myself  there  are  any  substantial  grievances. 
There  are  some  friction-points,  of  course,  like  in  all  new 
boots.  For  the  record  system,  the  card-index  is  I  under- 
stand to  be  substituted.  I  do  not  quote  the  East  End 
doctor,  but  what  is  a  more  trying  case,  namely  the  country 
doctor.  What  the  deficit  is,  if  any,  we  shall  find  out  in  the 
working  of  the  Act  ;  and  by  the  working  of  the  Act  alone 
can  we  find  out.  Why  imagine  results  ?  Let  us  work  and 
find  out  the  proper  figure.  The  Government  cannot  refuse 
it.  I  shall  be  delighted  to  speak  ;  but  at  present  it  looks 
as  if  the  nursery  motto  of  '  Speak  when  you  are  spoken  to  ' 
is  best. 

*  At  Christmas  time,  1913,  he  writes  thanking  her  for  another  tie  : 
'  Hardy  annuals  are  most  agreeable,  and  to  present  needs  most  opportune 
and  likely  to  be  tested,  since  I  am  just  off  to  Norway  with  my  family 
to  a  snow  hotel  4000  feet  up,  and  where  we  are  told  the  snow  is  now  six 
feet  deep.  I  shall  without  doubt  be  identified  when  found  by  the  briUi- 
ancy  of  my  tie.  So  you  will  have  done  more  than  one  noble  act  by  your 
labours  and  sacrifice.  Why  you  go  about,  and  yet  no  nimbus  discernible, 
baffles  me  :  but  of  course  we  have  not  employed  Mr.  Stead's  photographer. 
Probably  a  well-ordered  plate  would  show  the  nimbus,  especially  one 
of  such  spiritual  character,  most  distinctly  ;  and  no  mere  ring,  but  a  good 
4th  century  6-in.  broad  one.' 


VI 

The  Fight  against  Alcohol 


It  is  a  common  belief  that  physicians  and  surgeons  who  are 
opposed  to  the  use  of  alcohol  have  slowly  made  up  their 
minds,  by  observation  of  many  patients  and  feeling  of 
many  pulses.  Horsley  made  up  his  mind,  in  boyhood,  by 
observation  of  himself ;  which  may  be  the  best  way  of  all. 
He  was  reading  for  one  of  his  examinations,  and  found  that 
he  could  read  better  of  an  evening  if  he  took  neither  beer 
nor  wine  at  dinner.  At  University  College,  he  and  his  friend 
Walter  Pearce  upheld  the  cause  of  total  abstinence,  in 
debates  and  in  talk.  Doubtless  his  influence  would  have 
been  greater,  if  he  had  not  also  been  opposed  to  smoking, 
and  to  the  use  of  '  condiments  '  :  but  any  fellow-students 
who  put  his  abstinence  from  alcohol  on  a  level  with  these 
other  abstinences  did  not  properly  know  what  they  were 
looking  at. 

On  October  4,  1882,  he  gave  a  lecture  to  the  St.  John 
Baptist  Total  Abstinence  Society,  entitled  '  Is  Alcohol  a 
Food  ?  '  This  is  the  earliest  record  of  his  lecturing  which 
has  come  to  hand.  In  1886,  at  a  meeting  of  medical  students, 
arranged  by  the  British  Medical  Temperance  Association, 
he  spoke  of  '  the  immense  public  influence  which  medical 
men  could  wield,  both  politically  and  socially,  in  promoting 
sobriety.'  In  January  1887,  at  a  meeting  of  the  National 
Temperance  League,  he  spoke  of  experiences  of  Hospital 
hfe :  he  said  that  in  London  90  per  cent,  of  the  injuries 
admitted  on  Saturday  nights  to  Hospitals  might  be  attri- 
buted to  drink  :  that  in  two  Hospitals  known  to  him  every 
admission,  on  Boxing  Day,  1886,  had  been  due  to  drink  : 
that  as  small-pox  and  rabies  were  kept  down  by  law,  so 
ought  law  to  restrict  the  drink-trade. 

280 


LC.C.  Slums  l^-'cui  Drink  Trade  . 
Drink S hops .  South wark .w;. Tabard  S-  Dis : rict. 


^^^ 


^"SES.^.p^^,L.o=OlHCR"ON".B.O|-r. 


Map  of  Southwark  Area.     From   Horsleys   Presideiuial  Addrcoo 
to  the  National  Temperance  Federation,   1914. 


THE  FIGHT  AGAINST  ALCOHOL         231 

In  1888,  a  man  working  with  him  put  this  question  to 
him — I  have  tried  to  give  up  both  alcohol  and  tobacco  : 
I  find  that  I  cannot  give  up  both  :  which  ought  I  to  allow 
myself  ?     Horsley  wrote  back  : 

August  23.  Smoking,  of  course.  But  I  dare  say  you 
don't  really  care  to  go  back  to  it :  the  stale  odour  is  too 
dreadful.  Re  your  consumption  of  alcohol.  You  must 
not  misunderstand  me.  It  may  be,  for  aught  I  know  of 
your  internal  mechanism,  that  alcohol  may  be  necessary 
to  you  as  a  drug.  If,  as  it  seems,  you  take  it  rather  as  a 
hypnotic,  I  would  very  strongly  recommend  you  to  try 
food  instead  :  and  if  you  can  take  it  I  think  that  there  is 
nothing  in  the  world  so  good  as  hot  milk  and  biscuits,  about 
half  an  hour  before  bedtime.  If  this  is  unpalatable  to  you, 
take  what  you  Uke  :  but  it  must  be  digestible  within  a  short 
time.  Write  again  when  you  have  made  the  experiment : 
but  I  must  not  give  you  much  advice  in  absence  of  knowing 
what  your  constitution  is.  October  22.  I  am  so  glad  you 
are  better,  and  so  soon.  The  disappearance  of  alcohol  and 
tobacco  is  apt  to  make  their  absence  painful  for  months 
rather  than  weeks. 

In  1892,  he  became  a  Vice-President  of  the  National 
Temperance  League  ;  and  gave  an  address,  at  its  annual 
meeting,  on  alcoholic  paralysis,  and  on  the  reduction  of  the 
use  of  alcohol  in  Hospital  practice.  He  always  had  a 
special  hking  for  his  chart  of  the  alcohol  coming  down, 
and  the  milk  going  up,  through  fifty  years,  in  seven  great 
Hospitals  in  London  :  their  total  annual  expenditure  fall- 
ing, in  alcohol,  from  £8000  to  £1200,  and  rising,  in  milk, 
from  £3000  to  £12,000. 

In  1896,  he  was  asked  to  be  President  of  the  British 
Medical  Temperance  Association. 

About  1898,  he  accepted  without  reserve  the  evidences 
of  science  that  even  very  small  quantities  of  alcohol  hamper 
the  machinery  of  the  brain.  Innumerable  experiments,  by 
Kraepehn  and  Aschaffenburg  and  others,  carefully  planned 
and  controlled,  and  extended  over  a  period  of  ten  years, 
had  proved  that  a  dose  of  alcohol  speeds  up,  for  a  few 
minutes,  the  simpler  acts  of  consciousness,  and  then  retards 
them  for  some  hours  :  but  it  retards  the  more  complex  acts 
right   away,   without   any   prehminary  speeding   up.     For 


232  SIR  VICTOR  HORSLEY 

example,  it  enables  a  man,  for  a  few  minutes,  to  be  quicker 
at  answering  a  word  or  a  signal  suddenly  given  to  him  ;  and 
then,  for  some  hours,  it  makes  him  slower  at  answering  : 
but  it  retards,  right  away,  his  power  of  doing  sums  in  his 
head,  memorising  sentences,  and  associating  ideas  one  with 
another. 

On  these  and  the  hke  observations,  and  on  other  evidences 
and  arguments,  Horsley  founded  his  behef  that  even  those 
non-abstainers  who  are  strictly  temperate  are  doing  hann 
to  themselves  :  and  in  1900,  when  he  gave  the  Lees  and 
Raper  Memorial  Lecture,  he  put  the  whole  case  for  science 
against  the  non-abstainers.  The  lecture  is  published  in 
pamphlet  form,  under  the  title  '  The  Effect  of  Alcohol  on 
the  Human  Brain.'  He  began  with  a  statement  of  his 
theme : 

I  propose  to  summarise  the  work  that  has  been  done 
most  recently  on  the  effect  of  taking  into  the  body,  not 
of  large  doses  of  alcohol  (for  we  all  recognise  that  as  in- 
jurious) but  of  those  small  quantities  which  are  ordinarily 
used  at  meal-times  and  are  spoken  of  as  dietetic. 

He  described  the  anatomy  of  the  brain,  and  the  structure 
and  arrangement  of  its  cells  and  fibres,  and  showed  lantern 
photographs  of  them.  Then  he  came  to  the  work  of  Krae- 
pelin  and  Aschaffenburg  ;  his  own  experiments  with  anaes- 
thetics, long  ago,  on  himself ;  the  use  of  Kraepelin's  tests, 
which  he  demonstrated  to  the  audience  ;  the  special  action 
of  alcohol  on  the  cerebellum  ;  and  the  degenerative  changes 
in  the  brains  of  drunkards.  He  was  careful  to  say  that 
these  gross  and  ruinous  changes  occur  only  in  extreme 
alcohohsm  ;  he  appealed  not  to  the  evidences  of  the  post- 
mortem room,  but  to  the  dehcate  measurements  of  a  man's 
quickness  of  response  and  strength  of  grip  ;  and  to  the 
rather  vague  deductions  which  are  drawn  from  the  action 
of  alcohol  on  lower  forms  of  life  : 

The  practical  argument  for  total  abstinence  is  based  on 
the  irrefutable  proofs  derived  from  physiological  investi- 
gation. .  .  .  From  a  scientific  standpoint,  the  contention 
which  we  have  so  often  had  put  before  us  by  our  friends, 
that  small  doses  of  alcohol,  such  as  people  take  at  meals. 
Lave   practically    no   deleterious   effect,    cannot    be   main- 


THE  FIGHT  AGAINST  ALCOHOL         233 

tained.  .  .  .  We  can  only  come  to  one  conclusion,  that 
from  a  scientific  standpoint  total  abstinence  must  be  our 
course  if  we  are  to  foUow  the  plain  teaching  of  truth  and 
commonsense. 

It  may  be  wrong  to  divide  into  periods  the  record  of  his 
fight  against  alcohol :  but  this  lecture  seems  to  mark  the 
end  of  what  may  be  called  his  early  period.  He  now  had 
evidences  against  temperance — we  must  not  play  fast  and 
loose  with  words  :  total  abstinence  may  or  may  not  be  a 
better  thing  than  temperance,  but  it  is  not  the  same  thing 
as  temperance — evidences  which  to  him  were  '  irrefutable 
proofs.'  They  are  of  no  light  weight :  but  he  is  begging 
the  question,  when  he  calls  them  physiological.  They 
are  physiology  vitiated  by  experimental  psychology.  His 
appeal  to  science  is  up  against  the  temperate  man's  appeal 
to  individual  experience,  to  the  only  hfe,  his  own,  of  w'hich 
he  has  first-hand  knowledge.  By  innumerable  experi- 
ments in  psychology,  it  has  been  proved,  that  the  equivalent 
of  the  temperate  man's  wine  or  beer  at  dinner  or  supper 
slows  '  ideation  '  ;  the  adding  up  of  figures,  the  memorising 
of  sentences,  and  so  forth.  The  temperate  man  can  still 
answer,  '  But  I  am  fairly  sure  that  it  does  not  slow,  but 
quickens,  my  evening's  enjoyment  of  music,  reading,  home- 
hfe.  I  add  up  and  memorise,  all  day  long,  in  the  City  : 
if  that  be  what  you  call  ideation,  I  say  that  I  mean 
something  different,  of  an  evening,  from  that.'  On  this 
borderland  between  collective  experiments  and  individual 
experience,  neither  the  total  abstainer  nor  the  temperate  man 
is  moving  among  physiological  facts  :  they  are  both  of  them 
arguing  from  psychology,  the  one  from  observations  made 
on  great  numbers  of  men,  the  other  from  observations  made 
on  himself. 

II 

After  1900,  Horslcy  led  the  fight  against  alcohol  in  this 
coimtry.  It  had  many  leaders,  but  none  quite  equal  to 
him,  with  his  authority  in  science  and  practice,  his  mastery 
of  the  art  of  lecturing,  his  constant  use  of  a  wealth  of  dia- 
grams and  kintcrn-shdcs,  his  courtesy  toward  his  audiences  ; 


234  SIR  VICTOR  MORSLEY 

he  knew  exactly  how  to  keep  the  happy  mean  between  tall 
talk  and  condescending  talk,  and  how  to  answer  questions. 
It  is  possible  that  he  did  not  make  enough  of  the  fact  that 
our  bad  habits  mostly  contain  something  which  must  be 
called  our  own  fault.  It  is  possible,  also,  that  his  lectures 
would  have  been  the  better  for  more  lightness  :  there  is  a 
pleasant  touch  of  relief  in  one  of  them,  where  he  describes 
our  three  most  British  institutions,  John  Bull,  Father 
Christmas,  and  Henry  viii,  as  examples  of  fatty  degenera- 
tion due  to  chronic  alcoholism  :  but  these  touches  are  rare. 
He  was,  of  course,  in  great  demand  ;  and  it  is  only  a  few 
of  many  occasions  which  can  be  noted  here. 

In  1902,  at  the  '  temperance  breakfast '  of  the  British 
Medical  Association,^  he  spoke  on  the  Peel  Report.  Here, 
of  all  questions,  he  said,  was  a  medical  question  :  yet  the 
Report,  from  cover  to  cover,  dealt  with  drink  as  a  purely 
social  question.  It  was  the  duty  of  the  medical  profession 
to  make  everybody  see  that  drink  was  essentially  a  question 
for  science  to  decide.  And,  as  a  matter  of  science,  the 
profession  ought  to  be  more  strict  over  the  wording  of  death- 
certificates  :  they  ought  to  name  chronic  alcoholism,  in 
every  case  where  it  had  been  a  cause  of  death  :  no  exact 
figures  of  the  mortality  from  drink  had  been  given  to  the 
Commissioners. 

In  1903,  at  a  Sunday  meeting  in  St.  James's  Hall,  he 
spoke  of  the  new  temperance  movement  in  France  ;  and 
opposed  the  pohcy  of  compensation  in  our  country  :  '  Why 
should  we  compensate  people  for  doing  us  harm  ?  '  Be- 
sides, grocers'  licences  had  been  thrust  on  the  community  : 
'  What  are  we  going  to  do  with  them  ?  Are  we  going  to 
compensate  the  grocers  too  ?  '  In  1903  also,  at  the  Medical 
Institute  of  Binningham,  he  gave  an  address  on  Alcohol 
and  the  Medical  Profession.  They  knew,  he  said,  better 
than  any  class  of  men,  the  evils  of  alcoholism ;   they  saw 

•  Long  before  1902,  this  breakfast  had  become  an  event  of  each  annual 
meeting  of  the  Association.  He  was  always  keen  for  its  success,  and 
enjoyed  speaking  at  it  :  for  example,  in  1892,  ho  denounced  the  adver- 
tisements of  secret  remedies  against  alcoholism.  It  was  not  an  official 
event,  and  it  needed  men  like  him  to  run  it  in  the  earlier  years  :  he  writes 
so  late  as  191 1,  '  I  have  always  till  the  last  two  years  had  to  watch  its 
welfare.' 


THE  FIGHT  AGAINST  ALCOHOL         235 

what  went  on  behind  the  scenes  of  the  social  hfe  of  the 
nation  ;  they  knew  not  only  that  the  number  of  deaths 
from  chronic  alcohohsm  was  far  greater  than  the  number 
pubhshed,  but  that  moral  deterioration  from  drink  came 
long  before  the  bodily  signs  of  drink  :  and  he  thought  that 
medical  men  ought  to  take  up  a  much  stronger  position — 
that  they  ought  to  say,  when  patients  asked  whether  it 
would  not  be  wise  to  take  a  little  alcohol, '  No,  it  is  not 
wise.' 

In  Birmingham,  Dr.  Mary  Sturge  asked  him  to  meet  Miss 
Lowenstein,  who  wanted  his  help  to  get  the  teaching  of 
hygiene  and  temperance  introduced  into  schools,  by  means 
of  a  petition  from  the  medical  profession  to  the  Board  of 
Education.  He  set  to  work  at  once  ;  a  strong  Committee 
was  formed  in  London,  with  Sir  William  Broadbent  as  Chair- 
man ;  a  petition  was  sent  for  signature  to  every  practitioner 
in  the  United  Kingdom  ;  and  Miss  Lowenstein  came  to 
London,  '  to  fetch  and  carry.'  She  remembers  him  at 
Cavendish  Square,  one  evening,  coming  in  just  at  dinner- 
time, and  asking  her  to  get  out  some  papers.  '  The  gong 
\nll  sound  in  a  minute,'  she  said.  '  And  why  should  we 
waste  a  minute  ?  '  he  said  ;  and  took  the  papers  to  the 
dining-room,  corrected  a  proof  with  his  left  hand,  fed  him- 
self with  his  right,  and  joined  in  the  talk — '  it  was  always 
easy  to  him  to  do  two  or  three  things  at  the  same  time  ' — 
or,  as  Charles  Beevor  said,  '  Horsley  has  three  brains.'  The 
number  of  answers  from  practitioners  was  14,118.  Then 
came  the  long  business  of  a  detailed  scheme  for  the  teach- 
ing of  children  of  various  ages  ;  the  preparation  of  a  coun- 
terblast to  Sir  Michael  Foster's  syllabus  ;  and  the  siege  of 
the  Board  of  Education.  '  It  took  three  separate  deputa- 
tions, at  long  intervals,'  says  Dr.  Mar}'  Sturge,  '  before  the 
door  opened  even  a  crack.  Finally,  on  the  third  occasion, 
after  a  serious  and  rather  indignant  speech  from  Sir  Thomas 
Barlow,  the  Minister  of  Education  remarked  that  he  could 
not  understand  why  anything  so  obvious  had  not  iK'cn  done 
before.  Victor  Horsley  spoke  at  all  the  deputations  :  and, 
at  the  last,  he  gravely  urged  the  Board  of  Education  to 
appoint   a   Medical   Olficer,    and   described   how    long    the 


236  SIR  VICTOR  HORSLEY 

British  Medical  Association  had  desired  this  improvement. 
Soon  afterwards,  Dr.  George  Newman  was  appointed.' 

In  1906,  in  Toronto,  at  the  great  temperance  meeting 
held  during  the  Association-week,  Horsley  spoke  of  the 
reduction  of  alcohol  in  Hospital  surgical  practice  as  one  of 
the  results  of  Lister's  work  : 

I  would  remind  you  that  the  introduction  of  antiseptic 
surgery,  or  rather,  its  more  general  use,  occurred  about  1882. 
In  fact,  I  am  an  example  of  traditional  architecture  myself, 
because  I  was  brought  up  in  a  septic  atmosphere,  which 
gradually  developed  into  an  antiseptic  atmosphere,  and 
therefore  I  have  seen  this  change  [the  reduction  of  alcohol] 
in  the  treatment.  ...  I  believe  that  the  movement  really 
began  with  the  surgeons.  ...  It  is  one  of  the  innumerable 
benefits  which  have  resulted  from  the  discovery  of  a  great 
principle  by  a  great  discoverer.  Antiseptic  surgery  ren- 
dered unnecessary  the  treatment  of  cases  as  before  with 
alcohol. 

It  went  further  than  that  in  my  own  Hospital.  At  Uni- 
versity College,  when  I  was  a  student,  it  was  still  the  custom 
to  give  every  patient  who  was  going  into  the  theatre  three 
or  four  ounces  of  brandy.  That  was  the  custom  ;  it  was  in 
apostolic  succession  from  the  time  when  anaesthetics  were 
not  known.  .  .  . 

Then  of  course  as  regards  post -operative  conditions  again, 
during  the  last  twenty  years  we  have  had  a  whole  armamen- 
tarium of  drugs  which  serve  our  purpose  far  better,  in  getting 
rid  of  shock,  than  anything  like  alcohol,  which  has  a  long- 
continued  and  too  depressing  effect. 

In  1907,  he  and  Dr.  Mary  Sturge  published  their  book, 
'  Alcohol  and  the  Human  Body.'  It  is  a  great  store,  close 
packed  and  well  arranged,  of  references  and  evidences  from 
chemistry,  physiology,  pathology,  psychology,  and  economics 
— from  the  Navy  and  the  Army,  industrial  life,  hospitals, 
insurance  companies,  and  reports  by  medical  officers  of 
health  and  public  registrars — the  whole  argument  enforced 
with  sayings  of  men  whose  names  are  familiar  as  household 
words.  Here,  at  last,  was  the  long-needed  supply  of  muni- 
tions for  the  fight  against  alcohol.  The  plans  for  the  teach- 
ing of  hygiene  and  temperance  to  children,  over  which 
Horsley  worked  for  years  and  years,  had  brought  the  need 
of  a  manual  for  the  teachers  :  and  Dr.  Sturge  had  suggested 
to  Horsley  the  writing  of  the  book.     She  says  of  it : 


THE  FIGHT  AGAINST  ALCOHOL         237 

Forthwith,  hohday  time  though  it  was,  he  began  to  decide 
the  chapters,  and  settle  the  scheme  of  the  volume,  insisting 
on  putting  the  nervous  system  first  in  the  book. 

This  combined  work  went  on  for  three  years,  chiefly  on 
Sundays,  when,  after  a  surgical  morning  at  Queen  Square 
and  elsewhere,  and  a  dash  in  the  car  with  his  children  to 
look  at  the  outside  of  the  Tower  of  London,  or  possibly 
a  walk  with  them  in  the  Zoological  Gardens,  he  would  try 
to  settle  down  for  an  hour  or  so  to  the  book.  Mostly,  it 
was  written  in  the  drawing-room,  while  family  music  went 
on  as  an  enjoyable  undercurrent  —  interrupted  of  course 
by  the  telephone,  and  by  enquiries  from  Lady  Horsley  as 
to  the  answers  required  to  manifold  urgent  letters.  Callers 
were  rare  in  that  busy  house,  although  foreigners  dropped 
in,  and  young  medical  men,  or  often  Americans  who  were 
at  the  time  working  in  his  laboratory  :  these  all  received  a 
cordial  welcome  and  were  at  once  included  in  the  family 
group.  On  such  occasions  the  junior  partner  in  the  book 
was  apt  to  vanish  in  despair,  to  such  time  as  Sir  Victor 
came  to  look  for  her  and  to  report  either  the  coast  clear  or 
himself  willing  to  work  in  a  quieter  room. 

We  had  about  equal  shares  in  the  work  for  the  first  edition : 
but  it  was  Sir  Victor  who  provided  the  added  matter  of  all 
the  later  editions  :  he  always  carried  about  on  holidays — 
and  out  to  Egypt — a  copy  of  the  book,  into  which  he  pinned 
everything  that  he  might  wish  to  add.  Requests  from 
India  led  us  to  add  a  chapter  on  Alcohol  and  Tropical  Con- 
ditions, which  he  wrote,  and  submitted  to  Sir  Leonard 
Rogers.*  For  the  edition  of  1915,  he  wrote,  with  much 
else,  the  chapter  on  Alcohol  and  the  Services.  Thus,  the 
greater  part  of  the  book  is  of  his  making.  It  was  a  con- 
stant matter  of  satisfaction  to  him  that  the  Drink  Trade, 
as  he  always  called  it,  had  never  been  able  to  refute  one 
line  of  the  book. 

Among  his  papers,  are  more  than  a  hundred  answers  to  a 
circular  which  he  sent,  in  March,  1907,  to  the  Head  Masters 
of  our  chief  schools,  asking  them  (i)  Is  it  the  general  custom 
for  the  boys  in  your  school  to  drink  alcohol  {i.e.  beer,  wine, 

»  Sir  Leonard  Rogers  writes  to  him,  from  the  Medical  College,  Calcutta, 
November  29,  191 4  :  '  You  may  be  interested  to  hear  my  personal  experi- 
ence. I  came  out  to  India  just  twenty-one  years  ago  ;  and  soon  after, 
when  dining  with  eighteen  K.A.M.C.oHiccrs,  I  wa.siuske<l  what  I  wouhl  drink; 
and  when  1  replied  that  I  did  not  care  for  any  alcohol,  althougli  I  liavc 
never  been  a  signed  teetotaler,  I  was  told  I  sliould  be  dead  in  a  year  if 
I  did  not  take  any.  I  replied  that  I  would  sec  if  that  was  the  case  or 
not  :  and  I  have  never  taken  any  alcoholic  drink  since.  ...  I  have 
rarely  worked  less  than  ten  hours  a  day.  Of  course  I  have  a  good  con- 
stitution :  but  I  am  certainly  not  the  worse  for  having  taken  no  alcohol, 
and  am  probably  much  better  without  it.' 


238  SIR  VICTOR  HORSLEY 

etc.)  or  water,  at  their  principal  meal  ?  (2)  If  the  use  of 
alcohol  is  exceptional,  what  percentage  of  the  boys  take  it  ? 
By  1915,  the  year  of  the  fifth  edition,  20,000  copies  of 
the  book  had  been  issued.  It  has  had  influence  far  and 
wide.  A  separate  edition  was  issued  for  Sir  William 
Hartley  to  give  away  broadcast.  The  Tasmanian  Temper- 
ance Alliance  ordered  400  copies,  and  gave  them  to  the 
libraries  of  all  the  pubUc  schools  in  Tasmania.  A  school- 
master in  Oomaru,  New  Zealand,  ordered  20  copies  for 
his  senior  science  form,  and  wrote  to  Horsley  : 

It  is  my  earnest  endeavour  to  win  all  the  boys  (230)  of 
this  school,  year  by  year,  to  total  abstinence,  and  to  fortify 
them  with  sound  scientific  arguments.  One  half  the 
school  have  already  signed  the  pledge  of  total  abstinence, 
and  the  rest  will  fall  into  line  as  our  scientific  teaching 
convinces  them. 

Indeed,  the  book  so  attacks  and  pursues  the  non-abstainer 
that  it  seems  to  leave  him  no  hole  or  comer  to  creep  into. 
There  is  no  refuge  for  him  in  the  fact  that  alcohol  may  be 
regarded,  after  all,  as  partaking,  in  some  remote  way,  of 
the  nature  of  a  '  food  '  ;  the  claims  of  alcohol,  qud  alcohol, 
to  be  called  a  food  rest  on  the  deep  scientific  meanings  of 
that  word,  which  are  known  to  the  physiologists  only  ; 
he  is  well  aware  that  he  does  not  take  wine  or  beer  as  food, 
and  that  they  do  not  nourish  him  as  bread  and  milk  and 
bacon  nourish  him.  Perhaps  his  best  chance  is  to  hide 
himself  in  that  individuahsm  which  science  is  apt  to  over- 
look. He  can  say  that  the  results  of  a  glass  of  wine  on  him 
are  altogether  out  of  the  reach  of  science  ;  he  might  even 
say  to  science,  '  Who  would  have  thought,  sixty  years  ago, 
that  the  husks  of  rice — not  the  grain,  but  the  husks — contain 
a  ferment  which  is  essential  to  health  ?  Who  would  have 
thought  that  beri-bcri,  which  has  killed  nobody  knows  how 
many  thousands  of  human  beings,  comes  of  a  diet  of  rice 
deprived  of  its  husks  by  milling  ?  The  results  of  wine  on 
me  are  just  as  subtle  as  the  results  of  rice-husks  on  a  native 
of  the  Malay  States.'  He  might  thus  far  dare  science  to 
contradict  him  :  but  he  had  better  not  venture  on  gener- 
alities against  this  classic  of  the  hterature  of  total  abstinence. 


THE  FIGHT  AGAINST  ALCOHOL         239 

In  January  1908,  Horsley  spoke  in  Belfast  at  the  Jubilee 
meeting  of  the  Irish  Temperance  League. 

In  1909,  the  International  Congress  on  Alcoholism  was 
held  in  London  :  and  he  was  asked  to  be  President  of  the 
International  Association  of  Abstaining  Physicians.  In 
January  of  this  year,  he  gave  an  address,  at  Wliitefields 
Tabernacle,  on  Alcohol  and  the  National  Life.  It  contains 
his  douTiright  statement,  '  I  mean,  by  temperance,  total 
abstinence  '  ;  and  his  estimate  of  a  man's  right  to  please 
himself : 

Our  friends  take  alcohol  in  small  quantities,  because  it 
gives  them  pleasure,  because  they  like  it.  I  want  to  suggest 
that  such  men  should  reform  their  ideas  of  their  pleasures, 
because,  when  you  come  to  consider  the  universal  good- 
ness of  human  nature — I  am  not  a  believer  in  the  badness 
of  human  nature — when  you  come  to  consider  that  every- 
body has  in  them  a  majority  of  good  as  compared  with  evil, 
it  is  impossible  that  such  friends  can  have  examined  into 
the  question  of  what  really  constitutes  pleasure,  if  they 
go  on  saying  that  they  take  alcohol  because  they  like  it 
as  a  pleasure-giving  substance.  There  is  no  real  thing  in 
hfe  which  may  be  called  a  pleasure  unless  it  conduces  to 
the  physical  or  moral  benefit  of  the  individuals  of  our  race, 
and  this  cannot  be  said  of  alcohol. 

In  the  spring  of  1910,  Miss  Elderton  and  Professor  Karl 
Pearson  published,  from  the  Galton  Laboratory  for  National 
Eugenics,  their  '  First  Study  of  the  Influence  of  Parental 
Alcoholism  on  the  Physique  and  Ability  of  the  Offspring.' 
They  had  obtained  unexpected  results,  which  confused  the 
issues  of  the  fight  against  alcohol  and  bewildered  the  public 
mind.  An  account  of  their  method  must  therefore  bo  put 
here. 

They  describe  the  difficulties  of  the  investigation  ;  and 
the  ways  in  which  parental  alcoholism  may  affect  the 
offspring,  (i)  By  direct  heredity  :  '  The  child  is  defective, 
not  because  the  parent  is  alcohcjlic,  but  because  it  is  the 
product — like  the  parent — of  a  defective  germ-plasm.  Tlie 
child  may  be  physically  and  mentally  fit,  and  yet,  when 
adult,  may  exhibit  alcoholic  tendencies.'  (2)  By  cro.ss 
heredity  :  '  If  alcohoUsm  is  a  mark  of  a  defective  germ- 
plasm,  that  defect  may  take  one  form  in  one  individual  of 


240  SIR  VICTOR  HORSLEY 

the  stock,  and  another  form  in  a  second.  Such  associated 
lieredities  are  well  known  to  the  student  of  insanity  and  of 
human  deformities.'  (3)  By  enfeeblement  of  the  physique, 
or  possibly  of  the  germ-plasm,  of  the  parents,  with  alcohol. 
(4)  By  poverty,  neglect,  and  unwholesome  surroundings  at 
home. 

They  are  not  concerned  with  direct  heredity,  for  they 
are  dealing  only  with  children,  not  yet  of  an  age  to  exhibit 
alcoholic  tendencies.  Prohibition  of  the  sale  of  alcohol 
would  not  remedy  the  influence  of  cross  heredity  :  '  it 
could  only  be  met  by  the  prohibition  of  parentage  for 
members  of  affected  stocks.'  The  evils  of  sdcohohc  en- 
feeblement would  be  stopped  at  once  by  complete  prohibi- 
tion of  alcohol.  The  evils  of  environment  would  be  met 
either  by  complete  prohibition  of  alcohol  or  by  removal  of 
the  children  from  home.  '  Surely  it  is  worth  while  to  get 
some  hght  on  these  points,  before  we  tackle  this  great 
problem  of  alcoholism.' 

Next,  they  define  their  use  of  certain  words  : 

By  the  term  '  alcoholism,'  in  this  paper,  is  not  neces- 
sarily meant  the  '  chronic  alcoholism  '  of  medical  htera- 
ture.  We  believe  that  many,  possibly  the  majority,  of  our 
drinking  class  would  be  found  to  suffer  more  or  less  from 
chronic  alcoholism  ;  they  at  any  rate  in  the  opinion  of 
trained  social  workers — assisted  by  the  judgment  of  police 
and  employers — are  drinking  more  than  is  good  for  them 
or  their  homes.  On  the  other  hand,  by  '  sober '  is  not 
meant  total  abstinence,  but  cases  in  which  the  use  of  alcohol 
is  so  moderate,  if  it  exists,  that  it  does  not  appear  to  inter- 
fere with  the  health  of  the  individual  or  the  welfare  of  the 
home.  Such  then  is  the  distinction  between  '  parent  drinks ' 
and  '  parent  is  sober '  of  the  following  investigation.  '  Parent 
has  drinking  bouts '  denotes  a  third  well-marked  class  from 
the  standpoint  of  the  social  observer ;  namely,  periodic 
outbursts  of  alcohohsm,  usually  marked,  when  they  occur, 
by  more  obvious  immediate  detriment  to  health,  and  more 
intense  dcstniction  of  home  welfare,  e.g.  discharge  from 
emplo}Tncnt,  or  visits  to  the  police  court. 

They  take  two  sets  of  statistics :  (i)  the  Report  of  the 
Edinburgh  Charity  Organisation  Society,  (2)  an  account 
of  the  children  in  the  special  schools  of  Manchester,  by  Miss 
Mary   Dendy.     They  examine   these  evidences,   point   by 


THE  FIGHT  AGAINST  ALCOHOL         241 

point ;  and  they  come  to  conclusions,  some  of  which  neither 
they,  nor  anybody  else,  had  expected  : 

1.  There  is  a  higher  death  rate  among  the  offspring  of 
alcoholic  than  among  the  offspring  of  sober  parents.  This 
appears  to  be  more  marked  in  the  case  of  the  mother  than 
in  the  case  of  the  father :  and  since  it  is  sensibly  higher  in 
the  case  of  the  mother  who  has  drinking  bouts  than  of  the 
mother  who  habitually  drinks,  it  would  appear  to  be  due 
very  considerably  to  accidents  and  gross  carelessness,  and 
possibly  in  a  minor  degree  to  a  toxic  effect  on  the  offspring. 

0\ving  to  the  greater  fertility  of  alcoholic  parents,  the 
nett  family  of  the  sober  is  hardly  larger  than  the  nett  family 
of  the  alcoholic. 

2.  The  mean  height  and  weight  of  the  children  of  alcoholic 
parents  are  shghtly  greater  than  those  of  sober  parents  : 
but,  as  the  age  of  the  former  children  is  shghtly  greater, 
the  correlations  when  corrected  for  age  are  shghtly  posi- 
tive, i.e.  there  is  shghtly  greater  height  and  weight  in  the 
children  of  the  sober. 

3.  The  wages  of  the  alcohohc  as  contrasted  with  those 
of  the  sober  parent  show  a  shght  difference,  compatible  with 
the  employers'  dishke  for  an  alcohohc  employee,  but  wholly 
inconsistent  with  a  marked  mental  or  physical  inferiority 
in  the  alcoholic  parent. 

4.  The  general  health  of  the  children  of  alcohohc  parents 
appears,  on  the  whole,  shghtly  better  than  that  of  sober 
parents.  There  are  fewer  delicate  children,  and  in  a  most 
marked  way  tuberculosis  and  epilepsy  are  less  frequent  than 
cimong  the  children  of  sober  parents.  The  source  of  this 
relation  may  be  sought  in  two  directions  ;  the  physically 
strongest  in  the  community  have  probably  the  greatest 
capacity  and  taste  for  alcohol.  Further,  the  higher  death 
rate  of  the  children  of  alcohohc  parents  probably  leaves  the 
fitter  to  survive.  Epilepsy  and  tuberculosis  both  depend- 
ing upon  inherited  constitutional  conditions,  they  will  be 
more  common  in  the  parents  of  affected  offspring,  and,  prob- 
ably if  combined  with  alcohol,  are  incompatible  with  any 
length  of  life  or  much  size  of  family.  If  these  views  be  correct, 
we  can  only  say  that  parental  alcoholism  has  no  marked 
effect  on  filial  health. 

5.  Parental  alcoholism  is  not  the  source  of  mental  defect 
in  offspring. 

6.  The  relationship,  if  any,  between  parental  alcoholism 
and  filial  intelligence  is  so  sliglit,  that  even  its  sign  cannot 
be  determined  from  the  present  material. 

Finally,  they  sum  up.     The  danger  of  alcoholic  parentage 
lies  chicliy  in   the  direct  and  cross  hereditary   factors  of 

Q 


242  SIR  VICTOR  HORSLEY 

which  it  is  the  outward  mark  :  not  in  the  enfeebUng  influ- 
ence of  alcohol  on  the  parents,  nor  in  the  bad  surroundings 
of  home.     And  they  end  on  a  jarring  note  : 

We  fear  it  will  be  long  before  the  temperance  reformer 
takes  this  to  heart.  He  is  fighting  a  great  and  in  many 
respects  a  good  fight ;  and  in  war  aU  is  held  fair,  even  to 
a  show  of  unjustifiable  statistics.  Yet  the  time  is  approach- 
ing when  real  knowledge  must  take  the  place  of  energetic 
but  untrained  philanthropy  in  dictating  the  lines  of  feasible 
social  reform. 

This  imhappy  flourish  of  last  words  not  only  angered  the 
temperance  reformers  but  provokes  the  average  man.  What 
lines  of  feasible  social  reform  are  dictated  by  the  theory 
of  the  continuity  of  the  germ-plasm  ?  The  prohibition  of 
parentage  for  members  of  affected  stocks  is  not  feasible :  nor 
would  it  be  social  reform,  even  if  it  were  feasible. 

Among  the  opponents  of  the  memoir  were  Professor  Alfred 
Marshall  and  Mr.  J.  M.  Keynes,  Dr.  Kyle,  and  Dr.  Maurice 
Craig.  For  some  months,  Horsley  kept  out  of  the  contro- 
versy. But  in  1907,  a  httle  handful  of  medical  men  had 
spoken  up,  in  one  of  the  medical  journals,  for  alcohol :  this 
casual  statement  of  their  opinions  had  been  used  to  bait 
pubhc-houses :  and  Horsley  may  have  feared  that  the 
memoir  also  was  being  used  for  this  vile  purpose.  When 
he  did  enter  into  the  controversy,  he  and  others  carefully 
ransacked  the  Edinburgh  C.O.S.  Report,  to  get  the  exact 
family-history  of  the  1400  school  children  included  in  it. 
Dr.  Sturge  writes  that  '  they  had  imagined  that  at  least 
a  sprinkling  of  real  teetotalers  would  be  found — parents 
who  had  abstained  from  alcohol  for  some  years  before  the 
birth  of  their  children.  But  it  was  discovered  that  the 
real  teetotal  family,  where  both  parents  were  abstainers 
in  this  sense,  was  practically  absent  from  the  Report.'  That 
was  Horsley 's  strong  point  against  the  memoir  :  as  he  says, 
in  the  National  Temperance  Quarterly,  September  1910  : 

The  enquiry  purports  to  differentiate  between  alcoholic 
and  non-alcohohc  parentage ;  yet  there  is  no  indication  as 
to  whether  the  alcoholism  had  set  in  before  the  offspring 
were  bom  I  When  children  aged  fourteen  are  being  investi- 
gated, we  require  to  know  the  habits  of  the  parents  fifteen 


THE  FIGHT  AGAINST  ALCOHOL         243 

or  more  years  previously  I  Yet  ttiis  simple  precaution  has 
been  entirely  overlooked. 

Toward  the  end  of  1910,  the  authors  of  the  memoir  pub- 
lished their  defence,  their  '  Second  Study.'  They  say  that 
the  question,  as  to  the  habits  of  the  parents  before  the 
children  were  bom,  is  left  unanswered  by  several  writers  on 
parental  alcoholism,  whose  opinions  none  the  less  are 
quoted  by  Horsley  as  of  the  utmost  authority.  They  say 
also  that  the  solution  of  the  difficulty  raised  by  him  and 
others 

could  have  been  found  by  them  at  once,  had  they  studied 
the  data  in  our  memoir.  Of  the  alcoholic  parents,  a  slightly 
larger  percentage  of  the  offspring  falls  below  five  and  seven 
years  of  age  than  in  the  case  of  the  sober  parents,  30  per  cent, 
as  against  27  per  cent.,  and  the  ratio  of  the  number  of 
children  between  five  and  seven  to  those  between  twelve  and 
fourteen  is  for  both  drinking  and  sober  parents  i-6.  But  if 
the  parents  only  became  alcohohc  to  any  sensible  extent 
after  the  birth  of  their  children,  it  will  be  clear  that  the 
ratio  of  young  to  old  children  in  the  case  of  the  alcohohc 
must  be  very  different  from  what  it  is. 

In  January  1911,  Horsley  and  Dr.  Sturge  published  their 
answer,  '  On  some  of  the  biological  and  statistical  errors 
in  the  work  on  Parental  Alcoholism  by  Miss  Elderton  and 
Professor  Karl  Pearson.'  This  answer  produced  a  '  final 
answer.'  The  position  of  the  opponents,  at  the  end  of  the 
controversy,  is  for  experts  to  judge.  There  was  not  only 
the  deadlock  between  the  passionless  mind  of  eugenics  and 
the  passionate  mind  of  the  light  against  the  drink-trade  : 
there  was  also  the  want  of  agreement  over  the  meanings  of 
words.  To  the  authors  of  the  memoir,  the  temperate  non- 
abstainer  was  '  sober  '  :  Horsley  was  inchned  to  call  him 
'  alcoholic'     As  Dr.  MacNalty  has  written  : 

He  hated  compromise  ;  and  the  via  media  in  life,  wliicii 
so  many  men  prefer  to  traverse,  was  an  abomination  to  liim. 
I  was  working  one  evening  at  tlie  microscope  in  Cavendisii 
Square,  and  Sir  Victor  was  discussing  with  Lady  Horsley 
the  question  of  obteiining  some  signatures  to  a  memorial 
on  Temperance  Reform.  The  name  of  a  distinguished 
surgeon  was  suggested — a  most  temperate  person,  tliough 
not  a  total  abstainer — but  Sir  Victor  shook  his  head,  with 
the  comment,  '  He  is  an  alcoholic'     I  could  not  refrain 


244  SIR  VICTOR  HORSLEY 

from  smiling :  he  observed  me,  and  his  eyes  twinkled  with 
fun.  '  I  cannot  help  appreciating  Mac's  keen  sense  of 
humour,'  he  said. 

In  July  191 1,  at  the  Birmingham  meeting  of  the  British 
Medical  Association,  came  a  great  event  of  the  fight  against 
alcohol,  the  fifty  temperance  addresses  from  members  of 
the  medical  profession,  forty-four  men  and  six  women  : 
they  were  given  on  a  Sunday,  and  were  attended  by  15,000 
persons.  The  arrangements  in  Birmingham  were  made  by 
the  Brotherhood  and  federated  societies,  on  a  plan  worked 
out  in  London  by  the  Horsleys  and  Dr.  Sturge.  Horsley 
spoke,  in  the  afternoon,  on  Citizenship  and  Temperance 
from  a  medical  point  of  view  ;  and  in  the  evening,  on 
Unselfishness.  He  and  Lady  Horsley  had  invited  all  the 
speakers  to  tea  :  he  stayed  to  photograph  his  great  after- 
noon audience,  came  in  for  tea  late  but  very  happy,  and 
motored  off  to  his  evening  audience.  The  achievement  of 
these  fifty  addresses  in  one  city  on  one  day  was  reported 
everywhere.  The  doctors,  at  their  great  annual  meeting, 
had  shown  themselves  willing  to  be  public  teachers.  The 
example  set  by  Birmingham  in  191 1  was  followed  by 
Brighton  in  1913,  and  by  Aberdeen  in  1914. 


Ill 

In  the  later  years,  he  was  not  always  careful  to  be  civil  to 
this  or  that  man  who  differed  from  him.  And,  as  demo- 
cracy got  more  hold  on  him,  he  began  to  make  more  use  of 
this  argument  against  drink,  that  it  was  a  wrong  done  to 
the  people  by  the  enemies  of  the  people  ;  a  steady  poison 
thrust  on  the  poor  by  wealthy  brewers  and  distillei-s,  and 
sold  everywhere  under  the  protection  of  the  Government. 
In  the  earlier  years,  he  had  mostly  been  concerned  with  the 
evidences  of  science,  and  with  the  witness  of  his  profession. 
In  the  later  years,  he  was  more  concerned  with  the  ethics 
of  the  whole  business  ;  his  hatred  of  drink  began  to  be 
touched  with  denunciation  of  those  who  made  drink,  sold 
it,  or  profited  by  it :  and  he  was  often  speaking  to  audiences 
that  preferred  pohtics  to  science. 


THE  FIGHT  AGAINST  ALCOHOL 


245 


The  number  of  his  pohtical  and  temperance  addresses  in 
the  later  years,  and  the  range  of  them,  are  amazing.  Here 
are  two  months,  from  his  engagement-books  ;  one  before 
the  War,  the  other  during  the  War  : 


January    g. 
..       13- 

16. 
.,  17- 
,.       19- 


20. 
21. 
22. 
25- 


26. 


27. 
29. 


1913 

Temperance  Lecture  :  Belle  Isle. 

Finance  :  or  how  money  has  to  be  got  for 
nation's  needs. 

Temperance  Lecture  at  Deal. 

Market  Harboro'  meeting. 

(Sunday.)  Lecture  to  South-West  Ham  I.L.P. 
Subject,  The  Feeding  of  School  Children  : 
and  Clinics. 

Islington  Health  League. 

West  Leicester  and  Harborough. 

Quarterly  meeting  Land  Values. 

Islington  Health  League.  Lecture  on  Tuber- 
culosis. 

(Sunday.)  Plaistow.  Lecture  on  Feeding 
School  Children. 

Edmonton  Central  Hall.  Temperance  Cam- 
paign. 

Oxford.  Temperance  Lecture  to  Under- 
graduates. 


1915 

January    3.     (Sunday.)      P.S.A.,    St.    George's    Presbyteri.m 
Church,  Southend-on-Sea. 
,,         8.     Temperance  League,  Paternoster  Row. 

9.     National  Commercial  Temperance  League, Ilford. 
'  Total  Abstinence  the  only  true  Patriotism.' 
II.     Address   to   soldiers   and   friends,    Dc   Walden 
Ch.  Institute,  Regent's  Park. 
,,        13.     Temperance  Conference,  Caxton  Ilall. 

24.     (Sunday.)     P.S.A.,  Kingsway  Ilall.     '  I  low    to 
prevent  another  War.' 
,,       26.     Church  Lecture  Hall. 

28.     Aldershot,  A.S.C.  Theatre. 
„       31.     (Sunday.)     P.S.A.,  Woolwich. 


There  must  be  many  '  ofticial  lecturers  '  well  paid  for 
doing  less,  though  they  be  doing  nothing  else. 

In  1913,  by  the  unanimous  vote  of  the  Executive  Com- 
mittee, he  was  elected  President  of  the  Nation^U  Temperance 


246  SIR  VICTOR  HORSLEY 

Federation.  This  great  Federation,  founded  in  1884  by 
the  union  of  thirty  associations  for  temperance  or  for  total 
abstinence,  has  a  membership  of  two  and  a  half  millions.  At 
the  Annual  Meeting  in  February,  1914,  he  gave  his  Presiden- 
tial Address.  He  spoke  (i)  of  the  danger  of  '  disinterested 
management,'  with  special  reference  to  the  superiority  of 
Norway  in  temperance  legislation,  (2)  of  that  old  grievance, 
the  trade  in  medicated  wines,  (3)  of  the  action  of  the  Insur- 
ance Commissioners  toward  the  meeting  of  approved 
societies  on  licensed  premises.  Of  the  trade  in  medicated 
wines,  he  said  that 

The  point  of  view  of  the  medical  profession  was,  that 
alcohol  was  being  discreditably  thrust  ufx)n  the  people  vid 
the  medical  and  nursing  profession.  .  .  .  The  medical  pro- 
fession, so  far  as  it  had  gone,  had  cleared  itself  of  complicity 
in  this  dreadful  business.  The  British  Medical  Journal  had 
refused  to  insert  advertisements  of  these  wines  :  but  it  had 
done  more,  it  had  published  analyses  of  them,  and  had 
invited  the  general  press  to  insert  its  advertisements  of 
exposure  ;  but  many  leading  papers  had  refused.  There 
was  really  no  protection  for  the  public,  except  by  the  action 
of  the  medical  profession. 

He  soon  had  further  ground  for  complaint :  for  in  June, 
1914,  the  proprietors  of  a  medicated  wine  brought  an  action 
against  some  medical  men  who  had  pubhshed  a  pamphlet 
saying  what  they  thought  of  it,  and  got  ;f25o  damages  : 
they  had  claimed  £5000. 

With  the  War,  came  the  fight  against  the  rum  ration. 
He  was  in  the  wrong  here  :  he  spoke  and  wrote  in  a  style 
unworthy  of  him  :  besides,  the  attempt  of  the  Temperance 
Societies  to  stop  all  issue  of  rum  to  our  men  at  the  front 
ought  never  to  have  been  made.  He  was  quick  to  admire 
everything  else  that  was  being  done  for  the  welfare  of  the 
Army.  '  The  present  campaign,'  he  wrote  early  in  1915, 
'  with  the  single  exception  of  the  rum  ration,  has  been 
fought  on  physiological  and,  one  might  almost  say,  on  ultra- 
scientific  lines.  Everything  that  human  science  can  suggest 
has  been  brought  into  play  by  the  nation.'  But  he  was 
horrified  by  the  evil,  in  the  winter  of  1914-15,  of  the  heavy 
drinking  everywhere,  the  increase  of  drunkenness  among 


THE  FIGHT  AGAINST  ALCOHOL         247 

women,  the  crazy  treating,  all  the  steps  of  that  dance  on 
the  edge  of  a  precipice — to  him  it  was  heartbreaking  :  no 
wonder,  that  he  fought  furiously.  On  October  13,  he  said 
at  a  meeting  in  Manchester  : 

I  ask  you  to  get  the  Government  to  help  the  Army,  and 
not  to  hinder  it.  We  are  allowing  another  army  to  hang 
on  our  flank,  to  rob  us  of  our  reserves — the  army  of  brewers 
and  distillers.  In  peace  time  they  kill  60,000  every  year. 
The  enemy  put  horses  into  the  wells  to  poison  the  water 
for  our  soldiers,  but  one  of  our  Government  departments 
sends  out  poison  to  put  into  the  bodies  of  our  men.  I  have 
been  told  on  unimpeachable  authority  that  contracts  are 
now  entered  into  for  500,000  gallons  of  rum,  and  yet  every 
one  knows  that  that  stuff  spells  defeat  for  the  British  Army. 
It  saps  the  energy  of  the  soldier,  confuses  his  senses,  spoils 
his  shooting,  but,  above  all,  destroys  his  morals  and  his 
discipline. 

In  October,  also,  the  National  Temperance  Federation 
sent  out  a  memorial,  signed  by  Horsley  as  President  and 
Mr.  Guy  Hayler  as  Hon.  Secretary.  It  set  forth  '  the  con- 
tention of  the  Federation,  that  the  rum  ration  should  be 
immediately  abandoned,  and  a  ration  of  hot  refreshing  and 
sustaining  food  suppUed  in  its  stead.'  It  backed  this  facile 
advice,  as  follows : 

It  is  certain  from  the  experience  of  previous  campaigns, 
as  well  as  from  the  teaching  of  all  scientific  facts,  that  the 
wonderful  withdrawal  of  the  Expeditionary  Force  from 
Belgium  to  the  Mamc  would  have  been  gravely  endangered 
if  rum  rations  had  then  been  issued  to  the  troops. 

A  well  -  known  Member  of  ParHament,  to  whom  the 
memorial  had  been  sent,  wrote  to  correct  this  statement  : 
he  quoted  a  letter  from  a  friend  in  the  Irish  Guards,  wounded 
about  the  fifth  day  of  the  Retreat  to  the  Marne  ;  who  had 
said  that  but  for  the  rum  ration  at  night  he  did  not  think 
the  retreat  could  have  been  accomplished  : 

The  first  time  that  rum  was  issued  to  us  was  after  the 
retreat  from  Landrccics.  We  had  a  very  long  march  on 
the  top  of  stiff  fi/^'hting,  and  were  very  done.  Wc  had 
also  lost  our  kits  and  had  to  sleep  on  the  bare  ground,  which 
was  wet.  The  tot  of  mm  which  was  served  to  us,  75  per 
cent,  diluted  with  water,  made  us  feel  warm  and  sleepy. 
When  I  was  with  the  troops  it  was  not  served  regularly  every 


248  SIR  VICTOR  HORSLEY 

night,  only  when  one  had  had  a  very  bad  doing  and  needed 
it,  and  it  was  always  diluted  by  the  Quartermaster.  I 
cannot  tell  you  the  immense  difference  it  made  to  one's 
comfort. 

On  this  correspondence,  Horsley  commented  : 

On  looking  at  our  Memorial  again,  I  see  that  we  did  not 
say  anything  definite,  but  that  the  Retreat  '  would  have  been 
gravely  endangered  if  Rum  Rations  had  been  issued  to  the 
troops.'  Our  infomiation  was  to  the  effect  that  none  was 
given.  He  now  says  Some  was.  Our  comment  will  be. 
Was  it  ?  Then  we  are  sorry  to  hear  it,  for  it  grossly 
endangered  the  Retreat,  and  now  we  understand  why 
there  were  8000  missing  !  So  we  have  him  both  ways.  I 
am  very  glad  now,  as  I  do  not  trust  him.  .  .  . 

On  November  6,  he  wrote  in  the  Manchester  Guardian  : 

Rum  rations  are  being  issued  not  only  to  the  troops  in 
France  but  to  the  recruits  in  England.  The  Army  contracts 
last  month,  as  I  showed  in  the  Free  Trade  Hall  on  October 
13,  amounted  to  500,000  gallons.  The  mm  is  not  issued  as 
a  drug  at  all,  and  no  '  doctor's  prescription  '  is  ever  written 
for  it.  It  is  issued  by  the  quartermaster's  department 
as  an  intoxicant,  and  even  only  one-half  of  the  amount 
given  to  each  soldier  causes  a  falling  off  of  from  30  to  50 
per  cent,  in  the  accuracy  of  his  shooting,  besides  other  depre- 
ciation of  his  efficiency. 

On  December  3,  he  wrote  to  Admiral  Sir  George  King- 
Hall,  on  the  rum  ration,  and  on  the  popular  fallacy  that 
drinking  water,  with  spirit  added  to  it,  cannot  convey 
infection  : 

Many  thanks  for  your  valuable  letter,  which  came  as  a 
refreshing  counter  to  another  I  had  from  a  hard-worked 
clergyman,  who  had  been  told  by  an  officer  that  the  men 
in  the  trenches  '  must  take  their  rum  to  continue  alive  during 
exposure  in  the  trenches ' ! 

This  really  ridiculous  as  well  as  false  statement  is  entirely 
due  to  the  most  recent  Army  Regulations  —  see  8/Allow- 
ances/89,  1914,  p.  16,  Reg.  34 — which  says  the  rum  ration 
'  may  be  issued  under  the  authority  of  the  G.O.C.  when 
certified  (!)  by  the  senior  medical  officer  to  be  absolutely 
necessary  for  safeguarding  the  health  of  the  troops  '  I  I 

When  such  outrageously  false  statements  are  made  in  the 
King's  Regns.,  a  poor  clergyman  may  well  believe  all  the 
yams  he  hears  from  the  front. 


THE  FIGHT  AGAINST  ALCOHOL         249 

The  point  you  raise  is  another  well-worn  mis-statement. 
The  fact  is,  that  water  containing  infective  microbes  cannot 
be  sterilised  by  adding  the  rum  to  it.  The  best  case  I  know 
of  was  during  the  Caterham  epidemic,  1879.  A  groom 
rode  into  Caterham  from  a  place  10-12  miles  off,  and  drank 
a  glass  of  whisky  and  water.  He  returned  forthwith  to 
his  master's  house,  and  punctually  on  the  tenth  or  eleventh 
day  developed  his  typhoid,  to  the  extreme  astonishment  of 
every  one,  especicdly  his  doctor,  who  worked  out  the  cause. 
I  hope  you  will  denounce  this  cruel  and  dangerous  fiction. 

On  January  9,  1915,  at  a  temperance  meeting  at  Ilford,  he 
spoke  of  the  great  decrease,  of  late  years,  in  the  amount  of 
mm  issued  to  the  Navy  :  the  rule  had  come  into  force  that 
every  sailor  desiring  the  mm  ration  must  apply  for  it,  and 
that  those  not  applying  should  receive  ^V  of  a-  penny  a  day 
instead  of  it  : 

Rum  drinking  in  the  Navy  was  dying  out  ;  and  this  was 
shown  by  the  fact  that  the  log  in  days  gone  by  was  marked 
T  against  the  extraordinary  person  who  was  a  teetotaler, 
but  to-day  the  letter  marked  in  the  book  was  G  showing 
those  who  required  grog. 

This  month  w^as  a  heavy  uphill  time  :  as  it  is  noted  in  his 
letters  to  Mr.  Hayler  : 

January  12.  I  received  a  telegram  last  night  from  Boulogne 
that  my  second  son  was  there  wounded,  and  I  must  see  him 
to  satisfy  myself.  My  intention  is  if  possible  to  return 
by  the  afternoon  boat.  January  19.  This  wretched  Influ- 
enza has  washed  out  of  my  memory  many  things,  including 
the  enclosed  draft.  February  2.  Unfortunately,  having  to 
give  addresses  and  lectures  when  not  quite  recovered  from 
an  influenza  attack,  I  am  now  hors  de  combat  with  acute 
pharyngitis. 

On  January  30,  he  published  in  the  British  Mtdical  Journal 
his  article,  '  The  Rum  Ration  :  the  alleged  responsibility 
of  the  medical  profession  for  its  reintroduction.'  It  was 
reprinted,  and  quoted  everywhere  :  letters  thanking  him 
for  it  came  even  from  the  United  States,  India,  and  China. 
It  begins  with  an  account  of  the  introduction  of  rum  into 
the  Army  : 

The  spirit-drinking  habit  was  first  contracted  by  tlie 
British  Army  in  Flanders  during  Marlborough's  campaign 
at    the   beginning   of   thr   eighteenth    cmtury.  ...  It   was 


250  SIR  VICTOR  HORSLEY 

during  the  eighteenth  century  that  the  spirit  ration  became 
part  and  parcel  of  the  soldier's  diet,  and  hideous  punish- 
ments— that  is,  floggings  and  other  tortures — were  inflicted 
in  order  that  discipline  (so-called)  should  be  preserved 
among  the  unfortunate  men  whose  morale  was  ruined  by 
the  rum  given  to  them  by  their  superiors. 

Then,  the  evidence,  early  in  the  nineteenth  century,  of  Sir 
James  McGrigor,  Inspector-General  Fergusson,  and  many 
others,  proving  grave  harm  done  to  the  health  of  troops  by 
the  issue  of  spirits.     Then,  the  Crimean  War  : 

The  disasters  of  the  Crimea  campaign,  in  which  rum  was 
regularly  issued,  and  the  effect  of  many  years  of  condemna- 
tion and  protests  by  mihtary  hygienists  and  authorities, 
caused  a  cessation  of  the  rum  evil  until  about  thirty  years 
ago,  when  the  rum  ration  was  specifically  declared  by  the 
Regulations  to  be  reserved  for  the  exceptional  occasions  of 
flying  columns.  Even  in  1897,  the  issue  of  rum  was  made 
under  the  Army  Regulations,  and  each  ration  was  obhged  to 
be  paid  for — namely,  id.  by  the  man  receiving  it  .  .  .  The 
pernicious  rum  ration  is  now  completely  restored  to  the 
Regulations  and  dietary  of  the  soldier,  to  his  injury  and 
ruin. 

He  criticises  and  condemns  the  rule  as  it  stood  in  191 5. 
'  The  rum  ration  in  France,'  he  says,  '  is  not  issued  on  "  very 
exceptional  occasions,"  but  every  day  ;  and  in  one  case 
which  has  come  to  hght  it  was  issued  twice  a  day.  The 
practice  differs  according  to  the  views  of  the  officer  com- 
manding a  unit ;  but  from  being  sporadic,  as  ordered  in 
the  Regulations,  it  has  now  become  epidemic  and  constant 
up  to  the  present  date.'  Finally,  he  gives  a  list  of  its  ill- 
effects  : 

The  following  physiological  effects  have  been  observed 
by  mihtary  and  naval  officers  to  follow  from  the  issue  of 
the  mm  ration : 

1.  Decadence  of  morale.    Causation  of  grousing,  friction, 

and  disorder. 

2.  Drunkenness.     Punishments.     Degradations  in  rank. 

3.  Decadence  of  observation  and  judgment.     Causation  of 

errors  and  accidents. 

4.  Loss  of  endurance  and  diminution  of  physical  vigour. 

Causation  of  fatigue,  falhng  out  and  slackness. 

5.  Loss  of   resistance  to  cold.      Causation  of   chilliness, 

misery  and  frost-bite. 


THE  FIGHT  AGAINST  ALCOHOL         251 

6.  Loss  of  resistance  to  disease  (particularly  those  occur- 

ring  under   conditions   of    wet    and    cold),    namely, 
pneumonia,  dysentery,  typhoid  fever. 

7.  Loss  of  efficiency  in  shooting.     (Half  the  rum  ration 

causes  a  loss  of  40  to  50  per  cent,  in  rifle  shooting. 

The  Navy  rum  ration  causes  a  loss  of  30  per  cent. 

in  gunnery  shooting.) 
That  all  these  evils,  and  increase  of  the  difficulties  our 
men   have   already   to  contend   against   on   active  service, 
are  the  direct  and  invariable  result  of  issuing  the  rum  ration 
is,  of  course,  well  known. ^ 

But  who  are  the  military  and  naval  officers  ?  Are  they 
of  to-day  ?  How  many  of  our  officers,  in  1915 — let  alone 
1918 — would  say  that  grousing,  friction,  disorder,  drunken- 
ness, punishments,  degradations  in  rank,  decadence  of 
observation  and  judgment,  fatigue,  falling  out,  and  slack- 
ness, are  well  known  to  be  the  direct  and  inevitable  result 
of  issuing  the  rum  ration  ? 

About  this  time,  he  spoke  at  Eastbourne,  Cambridge, 
Fleet,  Ipswich,  Leeds,  and  Huddersfield.  He  was  angered, 
with  some  reason,  by  the  official  statements  in  the  House 
of  Commons,  March  1915,  as  to  the  difficulty  or  impossi- 
bility of  providing  any  alternative  for  rum  to  our  men  in 
the  trenches. 

On  the  eve  of  going  to  France,  he  writes  to  Dr.  Saleeby, 
March  27,  1915  : 

I  cannot,  alas,  help  you.     I  quite  agree,  and  see  that 
vodka's  character  is  going  to  be  put  on  a  level  with  other 

'  When  he  says  that  the  rum  ration  causes  grousing,  he  means  of  course 
that  men  grumbled  if  they  did  not  get  it  :  for  he  writes  to  a  friend,  December 
14,  1914,  '  1  wish  the  W.U.  people  were  at  the  bottom  of  the  sea,  for 
I  hear  the  men  grouse  most  abonunably  on  the  days  wlien  no  rum  is 
issued.'  For  loss  of  eiliciency  in  shooting,  he  had  as  evidence  (i)  the 
'  grog-curvo  '  worked  out  by  Captain  Ogilvy,  K.N.,  Gunnery  Instructor 
to  the  Navy,  (2)  tlio  experiments  made  in  the  Swedish  Army,  by  Stall- 
Surgeon  Mernetsch,  on  a  large  number  of  non-commissioned  officers  and 
men,  under  varying  conditions,  and  over  long  periods  of  time.  Some  sort 
of  answer  to  these  evidences  w;us  attempted  by  a  little  society  callcil  the 
'  True  'rem{)crance  Association,'  which  made  a  few  rather  worthless 
counter-experiments.  But  the  i.ssue  of  the  rum  ration  was  not  intended 
to  meet  the  need  of  accurate  marksmanship.  I  had  the  honour  of  knowing 
a  man  who  for  nearly  three  years  served  as  a  stretcher-bearer  on  the 
Western  Front :  he  was  killed  in  iiourlon  Wood  ;  I  know  that  he  bcheved 
that  the  rum  ration  was  not  altogether  useless:  and  I  put  this  young  Sir 
Galahad's  experience  above  a  thousand  experiments  not  made  under  the 
conditions  of  actual  fighUng. 


252  SIR  VICTOR  HORSLEY 

spirits  which  are  accused  of  poisoning  people  not  because 
they  contain  alcohol,  but  something  extra,  namely  x  an 
unknown  quantity.  One  of  the  worst  offenders  in  this 
particular  was  a  medical  officer  on  the  West  Coast,  in  the 
Report  to  the  Colonial  Office.  Unfortunately  I  am  going 
to-morrow  to  France  to  take  up  duty  there,  and  so  am  quite 
off  the  chance  of  finding  out  about  vodka,  but  I  will  about 
absinthe.  Re  Alcohol  and  the  Human  Body,  we  have  just 
completed  (practically  rewriting)  a  fresh  edition.  The 
racial  part  always  was  obsolete  and  just  patched.  I  am 
just  considering  one  rewritten  chapter  and  shall  be  glad 
of  your  suggestions.  We  are  in  some  complex  conditions 
with  the  pubUshers  re  all  these  changes,  but  hope  to  struggle 
out.  Thanks  for  your  enquiries.  Our  boy  is  here.  I 
have  picked  out  the  pieces  of  shrapnel  from  his  head,  and 
it  is  doing  well.  The  other  boy  has  healed  and  gone  back. 
Curses  on  the  Kaiser. 

And  there  are  two  letters,  one  from  Alexandria,  the  other 
from  Mesopotamia.  They  were  written,  one  a  few  months, 
the  other  a  few  weeks  before  his  death.  They  are  put  here 
in  full :  the  first  of  them  has  already  been  published  with  a 
dozen  alterations  calmly  made  in  it ;  and  it  is  better  to 
put  them  in  full  than  to  hint  at  them  '  by  pronouncing  of 
some  doubtful  phrase.' 

I.  To  Mr.  Guy  Hayler.    From  Alexandria,  Jan.  17,  1916 

I  do  not  know  what  Resolutions  your  agenda  paper  may 
contain,  but  I  hope  one  will  be  passed  asking  the  Constituent 
Associations  to  put  renewed  pressure  on  the  Government 
and  Lord  Kitchener  and  the  Army  Council  to  withdraw  the 
rum  ration,  and  to  amend  the  Regulations.^  As  regards 
this  second  point,  I  believe  that  a  Petition  to  the  King  will 
also  be  necessary. 

My  point  is  that  the  rum  ration  is  not  only  a  gross  injury 
to  the  rank  and  file,  but  it  constitutes  an  officially  sanctioned 
excuse  for  the  officers'  disloyalty  in  refusing  to  follow  the 
King's  example. 

The  position  in  point  of  fact  is  worse  than  disloyalty,  and 
really  amounts  to  insult  to  His  Majesty  as  titular  head  of 
the  Army,  for  whisky  and  liqueurs  are  the  rule  in  all  messes 


*  Before  1916  was  out,  the  rule  came  into  force,  '  Rum  is  only  issued 
to  the  troops  at  the  discretion  of  the  General  Officer  Commanding  on  the 
recommendation  of  the  Medical  Officer.  When  an  issue  of  mm  is  ordered 
for  troops  serving  with  the  Expeditionary  Forces  in  the  Field,  individual 
soldiers  who  have  an  objection  to  the  spirit  may  be  supphed  with  cocoa 
or  chocolate  instead.' 


THE  FIGHT  AGAINST  ALCOHOL         253 

at  all  hours.  Morning  visitors,  even  on  duty,  are  offered 
a  whisky  and  soda  as  a  matter  of  course.  As  a  typical 
instance  of  demoralisation  due  to  the  officers  drinking, 
the  following  is  sufficient.  The  Hd.  Qrs.  Staff  closed  the 
bars  in  Cairo  to  the  rank  and  file  at  5  p.m.  during  the  Christmas 
days.  This  nearly  caused  a  mutiny,  not  because  the  men 
wanted  more  drink  for  themselves,  but  because,  as  they 
said,  they  could  not  stand  the  sight  of  the  officers  drinking 
heavily  in  the  hotels  after  the  appointed  closing  time. 
The  men  set  fire  to  a  Staff  motor  car  outside  the  chief  hotel. 
Of  course  this  is  the  country  of  cheap  alcohol,  and  Cairo 
and  Alexandria  reek  with  whisky  and  every  fonn  of  vice. 

The  British  Medical  Journal  last  summer  entered  a  protest 
against  the  scandalous  whisky  drinking  among  the  ofiicers 
of  Kitchener's  Army  training  at  home.  These  men  we  are 
now  getting  out  here. 

The  lack  of  moral  courage  always  has  been  the  bane  of 
every  army,  and  the  result  of  it  is  shown  in  the  neglect  of 
the  men's  comfort  and  health.  The  further  result,  of  course, 
in  a  pestilential  place  hke  this,  is  a  heavy  sickness  rate  and 
a  steady  loss  of  fighting  efficiency. 

Our  enormous  loss  (about  5500  men  crippled  and  dead) 
from  frost-bite  and  cold  alone  was  due  to  several  factors 
in  wliich  alcohol  not  only  played  a  prime  part  directly,  but, 
in  my  opinion,  the  neglect  of  the  personal  care  and  treat- 
ment of  the  men  (which  also  was  a  large  factor)  was  due  to 
the  idle  satisfaction  which  whisky  drinking  produces  and 
leads  a  man  to  let  things  drift  a  bit. 

The  medical  considerations  in  army  affairs  are  so  entirely 
regulated  by  the  combatant  staff  that  if  these  officers  are 
rendered  somewhat  lazy  by  whisky,  then,  seeing  tliey  are 
absolutely  ignorant  of  healthy  principles  also,  the  inevitable 
consequence  is  the  ruin  and  destruction  of  the  private  soldier, 
about  whose  fate  many  of  them  are  absolutely  callous  and 
indifferent. 


2.  To  Mr.  M.  Fraser,  Bon  Accord,  Winnipeg.     From 
Mesopotamia,  May  15,  1916 

I  am  extremely  ol)liged  to  you  for  your  Militai-y  Poster. 
It  ought  to  be  in  tlie  office  of  every  Minister  and  official 
responsible  for  carrying  on  this  war.  That  is  to  my  mind 
the  most  distressing  part  of  these  campaigns.  The  directors 
of  mihtary  operations  are  practically  all  wliisky  drinkers, 
and  tlicrefore  wish  the  soldier  to  drink  too.  Out  here  in  this 
torrid  chmate  they  actually  still  issue  rum  instead  of  food 
and  sterile  water,  and  as  a  result  we  now  have  cholera, 
dysentery,  and  diarrhoea  to  contend  witli.     Any  one  would 


254  SIR  VICTOR  HORSLEY 

suppose  that  no  military  surgical  history  had  ever  been 
written  or  published. 

Our  gross  failure  and  stupidity  are  in  my  opinion  due  to 
the  whisky  affecting  the  intellectual  organs  and  clearness 
of  our  leaders.  Of  course  they  do  not  reahse  that  alcohol 
in  small  doses  acts  as  a  brake  on  their  brains.  If  they  did, 
they  would  have  sufficient  loyalty  to  follow  their  King's 
example. 

Fancy  to  yourself  the  position.  The  King  is  the  head  of 
the  Army.  As  he  went  teetotal  for  National  safety,  every 
military  mess  ought  to  have  followed  him.  Not  one  did  ! 
It  is  a  repulsive  exhibition  of  selfishness  and  luxurious 
treachery  to  our  Country. 


VII 

Brotherhood  Addresses 

He  had  desired  to  be  in  Parliament,  that  he  might  be  able 
to  do  more  for  democracy,  and  for  his  profession  :  he  would 
have  worked  hard  on  Committees  :  and  he  would  have 
taken  his  place,  outside  the  House  of  Commons,  as  a  man 
elected  to  speak  with  authority  to  decisive  audiences.  If 
he  had  been  returned  in  1910  for  the  University  of  London  ; 
if  he  had  steadily  submitted  himself  to  the  limitations  and 
the  discipUne  of  the  House  ;  if  he  had  hved  to  now — there 
is  no  saying  how  high  he  might  have  risen  in  the  world  of 
pohtics  :  he  might  well  have  been  put  at  the  head  of  the 
new  Ministry  of  Health,  and  would  have  done  enduring 
work  for  it. 

Market  Harborough  had  spoiled  everything.  It  had 
thrown  him  over  :  and  this  reverse  had  come  when  he  was 
at  the  worst  of  his  unpopularity  and  was  giving  offence  right 
and  left.  He  was  kept  out  of  one  thing  after  another. 
Quiet  Utile  committees,  with  nobody  on  them  whose  record 
in  science  and  practice  could  hold  a  candle  to  his,  were  of 
opinion  that  they  would  '  get  on  better  without  him.' 
Neither  his  own  profession,  nor  the  professional  politicians, 
dared  to  play  him  for  all  he  was  worth.  Opportunities  were 
entrusted  to  lesser  but  safer  men  :  and  he  was  left,  in  the 
world  of  pohtics,  to  find  his  audiences  for  liimself. 

It  is  waste  of  time  now  to  be  wishing  that  he  had  not  been 
so  lavish  of  his  presence.  He  was  aristocrat  turned  democrat : 
he  had  the  convert's  zeal  :  he  was  content,  or  more  than 
content,  even  with  audiences  which  were  not  half  good 
enough  for  liim.  Of  coui^sc,  he  never  got  to  Ix;  altogether 
one  with  his  hearers,  nor  to  be  wholly  unconscious  that  he 
was  in  rather  strange  company  :   he  went  to  them  as  their 


256  SIR  VICTOR  HORSLEY 

leader,  not  as  their  '  comrade  '  :  and  they,  happily,  were 
loyal  to  him,  and  proud  of  his  leadersliip. 

Some  of  us,  disliking  his  pohtics,  hardly  troubled  to  study 
his  principles.  We  are  able  now  to  dig  down  closer  to  the 
foundations  of  his  political  faith  :  we  have  the  rough  notes 
for  his  Sunday  afternoon  addresses  at  Brotherhood  meet- 
ings, 1912-15,  and  other  similar  meetings.  They  are  incom- 
plete, written  in  haste,  words  doing  duty  for  sentences,  his 
pen  rushing  across  half  a  dozen  sheets  of  folio  paper  in  the 
loose  far-flung  hand  which  was  '  Horsley  all  over '  :  but 
on  this  or  that  occasion  they  were  written  with  more  care, 
not  on  paper  but  on  small  cards. 

The  Brotherhood  Movement  arose  in  the  Free  Churches, 
some  thirty  years  ago,  out  of  their  P.S.A.  (pleasant  Sunday 
afternoon)  meetings.  The  Brotherhood  now  has  a  member- 
ship of  half  a  milhon.  Its  motto  is,  '  One  is  your  Master, 
even  Christ,  and  all  ye  are  brethren.'  Its  intention,  '  To 
be  non-sectarian,  and  to  know  no  party  pohtics.'  Its  ideal, 
'  To  win  the  people  for  Jesus  Christ.  To  lead  men  and 
women  into  the  Kingdom  of  God.  To  unite  them  in  Brother- 
hoods of  Mutual  Help.  To  encourage  the  study  of  social 
science.  To  enforce  the  obligations  of  Christian  citizen- 
ship. To  promote  the  unity  of  social  service.  To  promote 
international  brotherhood.'  The  Report  for  1916  says  of 
Horsley  that  he  had  been  '  among  the  greatest  of  Brother- 
hood men — apostle  of  the  war  against  disease  and  alcohol 
on  our  platforms,  member  of  the  London  Speakers'  League, 
a  man  to  whom  some  of  our  leadei-s  were  looking  as  a 
potential  National  President.' 

Sometimes,  for  an  address,  he  would  take  a  special 
subject :  for  instance,  the  Guilds  of  the  Middle  Ages  ;  or 
would  speak  on  behalf  of  some  special  fund  or  institution. 
More  often,  he  took  a  very  wide  range  :  for  instance  : 

Sympathy  in  Public  Affairs. 
The  Responsibility  of  Manhood. 
National  Progress  and  Unselfishness. 
Christian  Basis  of  Human  Action. 
Self-Sacrifice. 
Brotherhood  and  Socialism. 


BROTHERHOOD  ADDRESSES  257 

His  rough  notes  for  these  addresses  must  look  amiss 
in  print  :  but  they  so  clearly  show  his  mind  that  they 
may  be  useful  here. 

Sympathy  in  Public  Affairs.     (Leicester,  191 3) 

Am  I  my  brother's  keeper  ?  Yes.  Sympathy  through 
all.  Christian  ideal.  .  .  .  People  say,  '  That  's  not  my 
business,'  and  '  WTiat  is  everybody's  business  is  nobody's 
business.'  We  have  to  negative  this.  What  is  every- 
body's business  must  be  attended  to  by  everybody.  For 
that,  every  one  must  be  a  citizen.  Public  affairs  can  only 
be  well  carried  on  by  the  citizens,  actuated  by  s^Tnpathy. 
Men  and  Women  enfranchised.  Franchise  a  Public  Affair. 
Sad  want  of  sympathy  on  the  Franchise.  Propertied  men 
sajang  to  the  poor  man  and  lodger,  '  You  are  not  fit  to  have 
a  vote.'  Some  men  say  to  the  women  of  the  State  just  the 
same.  Not  a  httle  Hypocrisy  re  Violence :  people,  true 
patriots,  lose  control  when  the  authorities  are  purbhnd  to 
National  Progress.  .  .  .  Vista  of  National  Progress  :  men 
and  women  in  sympathy  voting  for  and  carrying  progressive 
legislation.  Want  of  sympathy  due  to  Individualism.  We 
must  constantly  remind  ourselves  we  are  our  brother's 
keeper  :  every  time  we  see  a  slum,  register  vow  to  help  legis- 
lation. '  We  live  in  an  Empire  where  the  sun  never  sets, 
and  in  slums  where  the  sun  never  rises.'  Every  time  we 
pass  one  of  those  vortices  of  illness,  misery,  and  death,  the 
doors  of  a  drink  shop,  resolve  that  day  to  help  the  starv- 
ing and  suffering  children  of  our  city.  .  .  .  Business  of  the 
World  :  relation  between  Nations.  Detestable  attitude  of 
our  Jingoes :  equally  detestable  attitude  of  the  Junkers 
in  Germany.  .  .  .  Montaigne's  position  '  The  honourable 
Vocation  is  to  work  lor  the  commonwealth  and  the  profit 
of  the  many.' 


The  Responsibility  0/  Manhood.     (Ferme  Park,  191 3) 

Responsibility  of  Each.  Xtian  Sociological  Scheme. 
Description  of  World,  St.  Luke  vi.  21-38  incl.  The  world 
full  of  offences  '  for  it  must  needs  be  that  offences  come, 
but  woe  to  that  man  by  whom  offence  cometh.'  Xtian 
view.  Instances  of  rcaUsation  of  manhood  responsibility, 
(i)  In  1643,  Cromwell  wrote,  acknowledging  men,  arms, 
and  subscriptions,  '  Sir,  I  understand  by  these  GentKmen 
the  good  affections  of  your  Young  Men  and  Maids,  for  which 
God  is  to  be  praised.'  (2)  In  1682,  Cromwell  was  dead. 
Degraded  Stuart  dynasty  restored.     Clear  to  all  tiiat  not 

R 


258  SIR  VICTOR  HORSLEY 

only  was  Charles  the  Second's  Court  Inferno  of  Corrup- 
tion, but  King's  successor  would  establish  Inquisition  and 
attack  Protestantism,  strength  of  Nation.  Taunton  (siege, 
war)  supported  principles  of  Liberty  of  Subject  and,  above 
all.  Liberty  of  Conscience.  An  Humble  Address  of  the  Young 
Men  of  Taunton  to  Edmd.  Prideaux  and  J.  Trenchard — 
members  of  ParUament  who  had  made  a  good  fight  against 
the  attacks  of  the  Court  Party  on  Liberty  and  Protestantism  : 
'  Sir,  Though  we  are  not  immediately  concerned  in  the 
electing  Members  to  serve  in  Parhament,  yet  we  are  deeply 
sensible  that  we  shall  bear  an  equal  share  with  others  in 
the  same  common  danger  and  universal  slavery  which  Hell 
and  Rome  have  been  and  still  are  attempting  to  involve 
our  Protestant  nation  in.' 

Read  George  Fox's  Journal — a  record  of  incredible  hard- 
ships and  suffering :  a  man  repeatedly  in  prison  and,  like 
many  reformers,  '  bound  over  to  good  behaviour,'  when 
explaining  and  advocating  Xtian  Principles.  Fox's 
record  even  exceeded  by  the  prison  treatment  of  Pamell. 
Treatment  of  Wesley. 

The  Christiaji  view  of  Citizenship  knows  no  class,  nor 
distinction  of  sex,  nor  differences  of  rich  and  poor.  In  the 
Christian  scheme  of  life,  all  are  equal.  Surely,  greatest 
stabihty  secured  when  the  Nation  links  to  itself  all  its  Citizens, 
men  and  women,  with  threads  of  equal  tension.  And  while 
all  are  morally  speaking  equal,  the  responsibilities  of  all  are 
equal.     This  is  the  true  Pohty  of  Citizenship. 

Christian  code  requires  equaUty  and  justice  between  the 
sexes  :  between  everybody.  Our  law  gives  neither  equality 
nor  justice.  The  gross  inequality  has  caused  Divorce  Com- 
mission to  report  for  its  removal.     Yet  actually  Lord 

dared  to  claim  a  dual  code  :  one  grade  of  morahty  for  women, 
and  a  lower  grade  for  men.  Fortunately  the  Commission 
treated  him  with  contempt.  Surely  an  acknowledgment  of 
the  Responsibihties  of  Manhood  will  stimulate  us  to  strive 
for  this  Higher  Equahty  of  Citizenship.  .  .  .  We  are  pro- 
gressing towards  the  Light.  I  confess  I  have  little  patience 
with  those  who  talk  of  Decadence.  I  see  no  sign,  but,  on 
contrary,  recognition  of  Responsibility.  Times'  leader, 
October  3,  1913,  on  Woman's  Part  in  Life.  '  When  women 
maintain  the  standard  of  sexual  morality  for  men  is  lower 
than  their  own  and  needs  raising,  it  is  impossible  to  deny 
the  charge.  .  .  .  This  is  not  a  question  of  puritanical  inter- 
ference or  bigotry  :  it  is  a  question  of  Ufe.  Vice  is  hostile 
to  life  :  it  is  death.  .  ,  .  Life  is  the  ultimate  reaiity  that 
we  know,  and  the  one  test  of  what  is  good  and  desirable  is 
whether  it  serves  life  or  not.'  No  paper  would  have  pub- 
lished a  passage  like  that,  five  years  ago. 


BROTHERHOOD  ADDRESSES  259 

Christian  Basis  of  Human  Action.     (Upper  Holloway,  1912) 

Faith,  Hope,  Charity — greatest  of  these  is  Charity.  Faith 
in  Principle.  ReUgious  opinions  differ,  but  P.S.A.  move- 
ment stands  for  Faith  in  Principles,  as  against  Expediency. 
Hope  :  striking  feature  of  true  rchgious  feeUng  :  firm  hope 
in  upward  Progress.  Cannot  understand  people  without 
hope.  Teaching  of  Science — incessant  progress  and  develop- 
ment— breeds  hope,  creates  hope  :  hope  that  is  justified. 
Charity,  what  it  is,  what  it  is  Not — attempt  to  undo  Evils 
that  ought  never  to  have  been  created.  True  Charity. 
Principle  of  the  P.S.A.  movement — For  God  and  Humanity 
— i.e.  Personal  service  in  Social  Work,  helping  others. 
Pessimism  :  low  views  of  Human  Nature.  Parkes  :  Law  : 
Lord  Salvesen  :  Article  ix.,  '  Man  is  of  his  own  nature  in- 
clined to  evil '  :  Lord  :  and :  example  of  a  large 

number  of  people  who  have  lost  Spirit  of  Charity,  says  we 
are  living  at  the  end  of  a  Great  Period.  People  more  humane, 
kinder,  much  keener  realisation  of  Duty  towards  our  Neigh- 
bour :  sympathy  with  Progress  and  Principle — evidence  of 
Coal  Strike.  Splendid  example  to  us  of  man  just  dead, 
Lister.  Consider  his  position — a  Quaker — home  surround- 
ings— plunged  into  atmosphere  of  dirt  and  suffering — state 
of  hospitals  '  sickening  and  heart-rending  ' — did  not  become 
a  Pessimist  :  an  Idealist  in  Charity,  Simplicity,  and  Sincerity, 
strong  in  faith  of  Progress  '  for  God  and  Humanity,'  knowing 
that  the  one  requisite  is  Principle  ...  no  pessimist,  but 
an  optimist,  and  above  all  a  worker  :  never  lost  faith  in 
Mankind,  nor  in  our  physical  and  moral  progress  :  thus, 
firm  believer  in,  and  practitioner  of.  Charity  in  its  highest 
development.  We  must  see  to  it  that  Statesmen  are  not 
led  aside  by  party  feeling  but  shape  legislation  on  the  lines 
of  true  Charity,  namely  Social  Betterment.  This  is  the  work 
and  Influence  of  the  Brotherhood  Movement.  Personally 
I  consider  this  is  the  real  trend  of  most  modem  Politics, 
and  that  we  are  indeed  on  the  Upward  Path.  .  .  . 

To  this  transcript  of  some  of  his  notes,  may  be  added 
some  of  the  passages  of  prose  or  verse  which  he  used  to 
quote  in  his  addresses.  He  took  th(Mn  from  many  sources  : 
and  they  are  put  here  without  attempt  at  arrangement  : 

Fate  holds  her  best  gifts  till  we  show 
We  've  strength  enough  to  make  her  let  them  go. 

God  make  the  Nations  see 
That  men  should  brothers  be, 
And  form  one  Family 
The  wide  world  o'er. 


26o  SIR  VICTOR  HORSLEY 

The  years  are  slow,  the  Vision  tarrieth  long, 

And  far  the  end  may  be  : 
But  one  by  one  the  fiends  of  ancient  wrong 

Go  out  and  leave  us  free. 

Too  long  the  gulf  betwixt 
This  man  and  that  man  fixt 

Yawns  yet  unspanned  ; 
Too  long  that  some  may  rest 
Tired  millions  toil  unblest : 

God  save  our  lowliest,  God  save  our  land. 

Look  not  mournfully  into  the  past ;  it  comes  not  again. 
Wisely  improve  the  present  ;  it  is  thine.  Go  forth  to  meet 
the  shadowy  future  without  fear  and  with  a  manly  heart. 

Dusummat.    Du  good  service  if  you  can.     Butdusummat. 

All  men  are  by  nature  equall  made  all  by  one  worckman 
of  lyke  myre,  and  howsoever  we  deceave  ourselves  as  dere 
unto  God  is  the  poorest  begger  as  the  most  pompous  prince 
living  in  the  Worlde. 

{Book  of  Ordinances,  Bricklayers'  Guild,  1400.) 

They  helped  every  one  his  neighbour,  and  every  one  said 
to  his  brother,  Be  of  good  cheer. 

{Motto  of  London  Trades  Newspaper,  1825.) 

In  a  Country  like  this,  where  the  public  business  of  the 
State  is  the  private  duty  of  every  citizen,  those  who  dechne 
to  use  their  pohtical  power  are  guilty  of  treachery  both  to 
God  and  man.  {Dr.  Dale.) 

It  is  plain  that  these  Brotherhood  addresses  were  very 
grave  discourses.  There  is  something  of  the  spirit  of 
Kingsley  in  them,  and  of  Ruskin  :  whom  he  calls  '  the  great 
master  of  sociology.'  He  is  hopeful ;  he  praises  '  optimism,' 
and  rails  at  '  pessimism  '  :  but  he  does  not  push  his  hopes 
in  advance  of  his  facts.  Admiration  of  the  heroes  of  Pro- 
testantism ;  familiar  use  of  the  Bible  prophets,  the  Psalms, 
and  the  sayings  of  our  Lord  ;  contempt  for  the  old-fashioned 
talk  about  Christian  resignation  ;  rage  at  the  ill-treatment 
of  children — '  killed,  violated,  starved,  tortured  ' — and  at 
fornication — '  Dead  Sea  fruit,  full  of  bitterness  and  cor- 
ruption ;  we  men  escape  condemnation,  whereas  woman 
realises  truth,  wages  of  sin  is  death  ' — all  these  are  in  him  ; 
and  he  gives  them  a  Christian  setting  ;  and  they  would  have 


BROTHERHOOD  ADDRESSES  261 

it  of  their  own  accord,  if  he  did  not  give  it  to  them.  For 
him,  Christianity  was  Christian  ethics  and  social  service  : 
these  he  took  and  worked  into  the  fabric  of  his  life  :  what 
he  did  not  feel  to  want,  he  did  not  care  to  take,  nor  to  pro- 
vide for  his  children.  His  ignorance  of  questions  of  doctrine 
shows  itself  in  a  letter,  so  late  as  1916,  where  he  refers  to 
a  well-known  man  '  who  did  not  believe  in  the  Immaculate 
Conception,  or  some  theological  central  point,  but  never- 
theless was,  and  maybe  still  is,  a  Canon  of  the  English 
Church.'  He  did  not  understand  '  abstract  thought.'  Such 
little  time  as  he  allowed  himself,  of  an  evening,  for  any 
reading  outside  science  and  practice,  he  loved  to  give  to 
archaeology  and  old  maps,  to  anything  and  everything  about 
Ancient  Rome,  to  history,  biography,  books  of  miUtary 
campaigns,  (He  hardly  ever  read  a  novel :  there  are  not 
half  a  dozen  references  to  fiction  in  the  whole  of  his  corre- 
spondence :    but  one  of  them  is  notable  :    he  writes  to  a 

man  in  1889,  '  For  heaven's  sake  drop  Mr. comme  une 

pomme  de  terre  chaude.  His  novel  is  simple  filth,  and  of 
a  puerile  kind.') 

If  he  had  cared  to  be  labelled,  he  would  have  written  the 
label  himself,  Agnostic,  in  his  big  masterful  hand.  One 
of  his  nurses  tells  an  amusing  story  of  a  lady  who  went  to 
him,  '  because  he  is  the  special  surgeon  for  my  case  :  but 
of  course,  if  it  hadn't  been  for  that,  I  would  never  have 
gone  to  a  man  who  is  so  very  agnostic'  It  was  no  part  of 
his  plan  of  his  hfe,  that  he  should  be  in  quest  of  '  the  reason 
o'  the  cause  an'  the  wherefore  o'  the  why.'  It  was  not  in 
his  temperament :  it  was  not  m  his  education.  He  had 
not  been  through  that  mill  of  reading  when  he  was  young. 
It  had  pleased  him  well  enough,  in  his  University  College 
days,  to  try  to  think  of  the  Absolute  :  but  that  pleasure 
does  not  last  long  ;  and  he  did  not  find  his  way,  in  the  later 
years,  to  any  books  which  compelled  him  to  listen  to  them. 
Popular  theology,  and  sham  metaphysics,  were  utterly 
distasteful  to  him  ;  and  all  the  fashionable  jargon  which 
pretends  to-be  systematic  thought. 

It  is  not  likely  that  he  would  have  determined  himself 
— if  he  had  hved  to  old  age — to  cultivate  '  the  will  to  believe,' 


262  SIR  VICTOR  HORSLEY 

or  to  follow  up  the  evidences  in  poetry  and  philosophy  to 
the  Christian  faith.  It  is  possible  that  he  would  have 
thought  it  merely  a  sign  of  the  failing  brain,  to  be  thus 
restless  for  assurance.  It  may  be  that  his  growing  sense 
of  the  world's  iniquities  would  have  driven  him  to  a  venture 
of  belief.  There  was  a  phrase  of  his,  '  the  powers  of  evil,' 
which  he  used  very  gravely,  in  the  years  just  before  the 
War :  it  might  have  taken  him  far  :  but  the  powers  of 
evil  were  still  on  their  thrones,  the  last  that  he  saw  of 
them. 


VIII 

Private  Practice.    Home  Life 

To  look  at,  he  was  a  man  created  for  friendship  and  for 
happiness.  It  was  a  pleasure  to  watch  his  face,  handsome 
and  sensitive,  with  his  feelings  displayed  in  it  without  con- 
cealment. He  had  the  grand  air ;  the  look  of  distinction, 
pride,  youth,  enjoyment  of  hfe  :  the  average  man  looked 
sadly  commonplace  by  the  side  of  him.  '  I  was  lucky 
enough,'  says  a  well-kno\\Ti  surgeon,  who  was  his  assistant 
in  private  practice,  '  to  be  associated  with  him  for  many 
years  ;  and  my  admiration  for  him  steadily  grew  throughout 
the  time,  and  under  conditions  in  which  bogus  "  greatness  " 
could  not  fail  to  betray  itself.  There  was  in  him  a  hint 
of  the  archangel  that  I  never  discovered  in  any  other  man, 
and  that  made  one  feel  that  he  could  never  be  anything  but 
young  and  strong.'  It  is  the  exact  phrase,  '  a  hint  of  the 
archangel  in  him  '  :  or  the  look  of  a  head  of  Apollo  on  a 
Greek  coin  :  but  the  upper  part  of  his  face  was  stronger 
than  the  lower  part.  His  eyes  were  dark  blue-grey,  deep-set, 
and  keen  ;  he  had  perfect  vision,  but  a  touch  of  colour- 
blindness :  and  he  and  his  brother  Gerald  had  a  httle 
'  flare  '  of  white  hair  above  the  forehead.  The  tone  of  his 
voice  and  laughter  was  very  musical :  and  he  and  Gerald 
had  a  way  of  pronouncing  th  as  v.  In  the  use  of  his  hands, 
he  was  absolutely  ambidextrous  :  he  had  been  left-handed 
to  begin  with.  He  could  even  draw  on  wood  equally  well 
with  either  hand.  His  movements  were  quick  and  purpose- 
ful. Al^says,  he  held  his  head  up  and  his  shoulders  back  : 
no  tricks,  no  pose  :  he  was  just  himself,  wherever  he  was. 
He  neit."ier  showed  off  his  gifts,  nor  could  he  hide  them  ; 
and  whtn  he  came  into  a  dull  roomful  of  guests,  there  was 

an  odd  effect  as  if  the  lamps  went  up  of  their  own  accord. 

let 


264  ^IR  VICTOR  HORSLEY 

There  are  lives,  and  his  was  one  of  them,  at  which  we  are 
able  to  warm  our  hands  :  the  pity  is,  that  so  many  people 
— it  was  more  his  fault  than  theirs — did  not  warm  their 
hands  but  burned  their  fingers  at  his  life. 

In  the  lesser  matter  of  clothes,  he  was  well  dressed,  but 
not  under  the  rule  of  the  tall  hat  and  the  frock-coat :  and 
his  example  helped  his  profession  to  get  rid  of  that  badge 
of  all  their  tribe.  There  was  something  in  the  look  of  his 
clothes  which  bespoke  his  everlasting  love  of  the  country  : 
besides,  he  was  the  first  consulting  surgeon  in  London  to 
use  a  bicycle  to  visit  his  patients,  and  he  could  not  cycle  in 
a  frock-coat  and  a  tall  hat.  (It  is  said  that  Mr.  Christopher 
Heath  found  him  on  a  Sunday  morning  cycling  in  the  garden 
of  Cavendish  Square,  and  there  and  then  rebuked  him 
through  the  railings.)  So  soon  as  he  had  a  car,  he  taught 
himself  to  drive  and  repair  it.  Dr.  Neale  remembers  an 
expedition  with  him,  in  the  early  days  of  his  motoring : 

I  had  a  patient  in  Bournemouth  ;  and  Horsley  and  Risien 
Russell  were  to  see  the  case  in  consultation  with  me.  Horsley 
could  only  go  on  Sunday  :  so  we  agreed  to  Sunday  :  but 
he  had  a  new  motor,  and  would  not  hear  of  going  by  train. 
So,  to  make  sure  of  getting  him,  we  submitted  :  and  at 
6  A.M.  started — we  three,  an  American  sui^eon  who  was 
staying  with  Horsley,  and  the  chauffeur — aL'  five  :  Horsley 
drove.  At  Winchester,  something  went  wrong  with  the 
petrol  tank.  '  You  fellows  go  and  have  breakfast,'  he  said, 
'  and  see  the  Cathedral :  I  '11  put  the  motor  all  right.'  So 
he  got  under  it,  and  did  put  it  right.  We  got  to  Bourne- 
mouth, saw  the  patient,  and  had  lunch.  Risien  Russell 
wanted  to  get  on  to  a  consultation  at  Bath.  '  All  right  : 
we  '11  drop  you  at  Salisbury.'  We  got  to  Salisbury  just  in 
time  to  see  the  train  leaving  the  platform.  '  All  right  :  we  '11 
drop  you  at  Reading.'  But  on  the  road  from  Sahsbury  to 
Reading  a  tyre  burst :  we  had  to  stop  and  buy  a  new  one  : 
happily,  we  had  the  money  between  us.  We  got  to  Reading 
about  midnight  :  the  last  train  to  Bath  had  gone  :  we  got 
to  Piccadilly  Circus  about  1.30  a.m. 

Dr.  MacNalty  writes  of  later  expeditions  : 

He  always  drove  himself,  and  said  that  he  could  not  bear 
to  sit  stiU  and  be  driven  by  another.  He  would  start  early 
in  the  morning,  motor  sixty  or  eighty  miles,  driving  himself 
all  the  way,  and  tlicn  perform  a  cerebral  operation  with 
unfaltering  hand  and  nerve.    He  said  it  blew  the  cobwebs 


PRIVATE  PRACTICE.     HOME  LIFE       265 

of  London  av/ay,  to  get  out  into  the  countr}'.  Meetings 
at  Oxford  or  Cambridge  of  the  Physiological  Society  always 
served  as  objects  for  these  expeditions :  Lady  Horsley, 
and  a  scientific  friend,  such  as  Dr.  Janet  Lane-Claypon, 
usually  were  with  us.  On  my  first  visit  to  Cambridge,  he 
insisted  on  taking  me  a  lightning  tour  of  the  Colleges,  in 
the  half-hour  before  tiie  Society  met  :  we  did  it  somewhat 
in  American  fashion.  Sir  Victor  striding  on  ahead  pointing 
out  the  beauties  of  Cambridge,  with  Dr.  Batten  and  myself 
at  his  side,  while  Dr.  Charles  Beevor  followed  at  some  dis- 
tance behind,  remarking  plaintively,  '  I  wish  Horsley  would 
not  walk  so  fast.' 

One  glorious  expedition  in  1908  I  remember  especially. 
It  was  the  end  of  January,  and  I  breakfasted  with  him  at 
6.30  :  we  started  off  soon  after  7  in  the  big  Daimler,  and 
motored  to  Warminster,  where  he  had  a  consultation  :  on 
the  way,  we  halted  to  look  at  Stonehenge  :  after  Warminster 
and  lunch,  he  showed  me  the  old  Sa.xon  church  of  Bradford- 
on-Avon  :  then  we  visited  Bath  :  and  returned,  ^vith  tea  at 
Marlborough  on  the  way,  and  reached  Cavendish  Square 
at  9.30,  having  done  over  two  hundred  miles. 

On  a  holiday,  his  love  of  the  country  and  of  open-air  life 
inspired  him  to  get  and  to  give  happiness  all  round.  If 
there  be  a  genius  of  holidays,  it  was  in  him.  In  the  earlier 
years,  there  was  neither  time  nor  money  for  more  than  a 
few  days  of  tramping  or  of  boating  :  but  he  dehghted  in 
every  mile  of  them.  In  the  later  years,  he  used  to  take  a 
big  country-house,  with  land  to  shoot  over  ;  and  he  and 
Lady  Horsley  were  incessantly  hospitable.  There  is  a 
pleasant  story  of  one  guest  saying  to  another,  '  Why,  the 
man  's  absolutely  selfless.'  And  he  was  selfless  not  only 
in  hospitality  but  in  his  will  to  give  up  everything  at  a 
moment's  notice,  and  travel  three  hundred  miles  to  London, 
for  nothing,  to  see  a  surgeon,  a  stranger  to  him,  who  needed 
his  help. 

So  many  of  his  friends  have  written  of  holidays  witli  him, 
that  two  of  thorn  must  speak  here  for  all  of  them. 

From  Dr.  Huxley 

About  ten  years  ago  he  and  Lady  Horsley  insisted  on  the 
whole  family  spending  Christmas  in  Norfolk  at  a  shooting- 
place  he  had  taken  :  a  serious  matter,  a  family  of  four  children 
besides  ourselves.     The  children  were  thoroughly  spoilt  and 


266  SIR  VICTOR  HORSLEY 

the  small  boys  came  out  shooting :  I  see  Victor  now,  having 
appropriated  Kit,  aged  six,  with  directions  to  hand  his 
cartridges  :  the  pheasants  came  streaming  over,  and  up 
went  his  gun,  with  no  results  except  a  roar  of  laughter  as 
he  realised  that  in  the  excitement  of  the  moment  he  had  been 
given  the  empty  cartridges.  Michael,  my  next  eldest  boy, 
and  he  carried  on  a  varied  correspondence.  Victor  collected 
postage-stamps  for  him,  and  used  to  send  them  in  a  vast 
envelope,  addressed,  on  one  occasion,  to  Michael  Huxley,  Esq., 
The  Comer,  The  Nursery.  Michael  addressed  his  letter  to 
Sir  V.  Horsley,  The  Arm-chair,  The  Consulting-Room. 

I  met  him  constantly  in  work,  and  learned  more  from  his 
metiiods  than  from  any  one  I  have  ever  known.  The  kindest 
of  men — he  was  ever  ready  to  operate  on  or  see  the  needy 
folks,  with  or  without  a  nominal  fee  ;  and  in  all  these  years 
I  never  found  his  considered  judgment  of  a  case  at  fault. 
I  have  seen  most  of  the  great  surgeons  of  our  time  operate, 
but  none  surpassed  him  in  dexterity  and  in  care  of  every 
detail  of  treatment.  .  .  . 

I  think  that  no  one  except  my  father  ever  cared  less  for 
pubUc  opinion,  as  long  as  he  thought  a  thing  was  right  to 
do  or  say. 

From  Mr.  C.  J.  Bond 

For  many  years  I  and  my  family  had  the  happiness  of 
spending  an  autumn  hoHday  with  Victor  Horsley  and  his 
family.  These  began  with  a  visit  of  a  few  days  to  Hinwick 
near  WeUingborough,  where  Horsley  rented  a  partridge- 
shoot  in  1897.  After  Hinwick,  came  a  shooting  at  Ashford 
in  Kent  :  wliQe  staying  there  I  persuaded  Horsley  to  take 
up  photography  ;  and  I  remember  the  interest  which  Sir 
Frederick  Bramwell,  his  father-in-law,  took  in  working  out, 
from  the  elongated  picture  of  the  moon,  the  relative  move- 
ments of  the  earth  and  moon,  from  a  rather  successful 
photograph.  Ashford  was  followed  by  shootings  at  Angmer- 
ing  in  Sussex,  Pitcaple  in  Scotland,  and  various  country- 
houses  in  Norfolk.  It  was  while  sta\ang  at  Worthing  that 
Horsley  persuaded  a  butcher  to  allow  him  to  kill  several 
bullocks  by  shooting  them  with  the  Lee-Metford  service  rifle  : 
he  was  at  that  time  interested  in  investigating  the  explosive 
effects  of  bullets. 

One  delightful  fortnight  spent  by  us  with  the  Horsleys  in 
the  island  of  Rousay  in  the  Orkneys,  August  1911,  ever 
comes  back  to  my  memory.  Mornings  spent  on  the  moor, 
or  in  fishing :  afternoon  explorations  of  cairns  and  old 
Pictish  burial  mounds  :  excursions  to  neighbouring  islands — 
E>Tihallow  \nth  its  monaster^',  Egilshay  with  its  ruined 
Saxon  church  dedicated  to  St.  Magnus,  Veira  with  its  seals, 


PRIVATE  PIL^CTICE.    HOME  LIFE       267 

all  were  visited  and  photographed  on  many  occasions.  The 
uninhabited  little  Holm  of  Scothess  gave  us  an  opportunity 
of  investigating  a  problem  of  odd  eye-colour  in  a  hybrid 
race  of  rabbits  which  flourished  on  the  island.  .  .  . 

These  holidays  on  Rousay,  between  1909  and  1914,  were 
full  of  happiness.  He  set  himself  to  be  useful ;  he  studied, 
with  Professor  Meldola's  help,  the  chances  of  reviving  the 
kelp-industry  ;  the  plans  for  a  better  medical  service  in 
the  Orkneys,  and  the  management  of  small  holdings  ;  he 
was  President  of  the  Orkney  Agricultural  Society,  and  a 
Life-member  of  the  Orkney  and  Shetland  Association  ;  and 
he  and  Lady  Horsley,  with  Mr.  John  Logie,  were  the  founders 
of  a  Co-operative  Society.     He  writes  to  Dr.  Mary  Sturge  : 

Trumland,  Rousay,  September  10,  1910.  We  have  had 
an  extraordinarily  fine  time  here.  Next  year  you  really  must 
come  and  see  how  delightful  it  all  is,  and  how  absolutely 
free.  I  am  writing  this  in  quite  burning  sun,  in  the  garden 
alcove,  with  honeysuckle,  bees,  etc. — writing  on  my  knee, 
which,  however  pleasantly  idle,  is  not  conducive,  as  you 
see,  to  copper-plate  style.  The  boys  are  in  great  feather, 
as  the  bag  of  seals,  grouse,  plover,  etc.  has  been  very  good, 
and  as  they,  including  a  school  friend,  and  I  made  a  raid 
on  the  North  Isles  as  far  as  Papa  (early  Xtian  missionary 
=papa)  Westray,  the  last  but  one  north.  There  and  at 
Westray  we  put  up  in  farms  under  conditions  rather  too 
primitive  for  some,  but  which  were  certainly  novel  and 
interesting.  We  walked  all  over  the  islands,  found  some 
birds  and  a  great  deal  of  interest  :  altogether  a  very  profit- 
able raid,  which  took  about  six  days.  We  are  holding  a 
tea  on  Tuesday,  endeavouring  to  start  a  Farmers'  Co-opera- 
tive Society,  at  a  school  four  miles  from  here  which  is  the 
only  building  on  this  island  capable  of  holding  about  120 
people.  Orkney  is  a  great  place  for  co-operation,  but 
may  be  made  more  so.  Altogether  socially  it  is  very  interest- 
ing. The  captain  of  the  North  Isles  little  coasting  steamer 
is  a  leading  temperance  advocate,  Craigie  by  name.  We 
must  send  him  a  copy  of  the  new  Edition,  or  more  Crom- 
wellio  the  New  Model. 

Next  to  these  holiday  letters,  come  letters  from  patients  : 
they  show  not  only  gratitude,  but  downright  reverence,  as 
if  the  writers  could  not  find  words  good  enough  for  him  : 
some  of  them  treasure  his  photograph,  or  a  few  lines  of 
his   handwriting :    they  praise    his   gentleness,   sympathy, 


268  SIR  VICTOR  HORSLEY 

generosity,  his  '  Heraclean  cheerfulness  and  courage.'  One 
could  paint  a  portrait  of  him,  from  these  letters,  as  the 
beloved  surgeon  ;  and  it  would  be  a  true  likeness.  But  of 
course  the  letters  fall  short  of  the  thing  itself.  As  a  letter 
says,  '  One  had  to  sec  that  toss  of  the  head,  and  a  sort  of 
flash  of  interest,  sympathy,  annoyance,  or  humour — elusive 
and  indescribable.' 

There  never  was  a  man  who  made  less  of  the  distinction 
between  Hospital  practice  and  private  practice.  What  he 
was  to  his  Hospital  patients  may  be  judged  from  three 
sayings  which  by  chance  have  been  remembered.  '  The 
patients  he  and  watch  for  his  coming,'  said  one  of  the  Staff 
of  University  College  Hospital.  '  I  think  it  was  through  Sir 
Victor,'  said  a  medical  man,  whose  life  Horsley  had  saved, 
'  that  I  tried  to  be  kind  to  poor  people.'  And  a  patient  in 
Queen  Square  said,  '  I  do  believe,  if  one  of  us  were  to  die, 
and  Sir  Victor  got  him  within  half  an  hour,  he  could  bring 
him  to  hfe  again.' 

Foolish  or  envious  people  said  that  he  '  advertised,'  that 
he  sought  popularity,  and  so  forth.  None  of  them  is  worth 
answering.  It  would  be  nearer  the  mark  to  say  that  he 
sought  unpopularity ;  that  he  was  attracted  by  causes 
which  were  in  disgrace.  As  for  advertising,  he  was  one  of 
the  very  few  men  who  never  felt  the  need  of  it.  His  record 
in  science  and  practice  dtivertised  him.  Even  before  he 
was  thirty,  his  profession  was  talking  of  him  as  the  coming 
man.  By  the  time  he  was  thirty,  everybody  was  beginning 
to  talk  of  him.  This  is  not  to  say  that  he  was  not  proud 
of  his  work  for  physiology  and  surgery  ;  he  was  openly 
proud  of  it.  Nor  did  he  take  much  trouble  to  hide  his  mind, 
when  patients  came  to  him  from  men  who  had  not  done 
the  very  best  thing  for  them.  But  that  is  not  what  his 
profession  means  by  '  advertising.'  He  was  in  public  life  : 
and  the  newspapers  made  it  their  business  to  tell  us  every- 
thing about  him.  They  told  us,  in  1897,  that  he  was  going 
to  Russia  to  attend  the  Tsar  ;  not  a  word  of  truth  in  it  ; 
he  could  hardly  write  and  proclaim  that  he  was  not  going  ; 
it  would  only  complicate  matters  :  then  comes  a  black- 
guardly anonymous  postcard  all  the  way  from  Dublin — he 


PRIVATE  PRACTICE.     HOME  LIFE       269 

kept  even^thing — '  Any  other  advertising  quack  couldn't 
have  done  better.  Bravo  Horsley  !  Advertise  away,  damn 
the  expense.' 

Over  his  fees,  he  was  very  generous.  He  would  not  take 
a  fee  from  a  veterinary  surgeon  :  and  during  the  War  he 
would  not  take  a  fee  from  any  wounded  officer  :  '  I  'm  not 
going  to  take  money  from  a  man  who  was  wounded  defend- 
ing me.'  His  rule  that  no  medical  man  should  pay  a  fee 
to  him  was  absolute.     One  writes  : 

I  do  hope  you  will  not  omit  to  note  specially  the  immense 
amount  of  work  he  did  for  his  medical  friends  without  any 
money  reward.  During  a  long  illness,  dating  back  to  1901, 
he  was  always  ready  and  willing  to  help  me  when  necessary. 
Once  he  came  down  to  Ventnor  to  see  me,  once  he  came 
here  ;  and  he  operated  on  me  at  least  thrice.  On  no  occasion 
would  he  take  any  payment :  '  Dog  does  not  eat  dog,'  he 
said.  On  one  occasion  I  tried  to  send  him  a  cheque  as  a 
Christmas  gift.  It  came  back  to  me  with  a  note  sa\ing 
that  if  I  wished  to  continue  his  friend  I  must  not  do  it  again. 

Another  doctor,  whose  daughter  Horsley  had  seen — a 
hopeless  case — away  from  her  home,  tried  to  convey  a  fee 
to  him  through  the  ladies  with  whom  she  had  been  staying. 
Horsley  found  this  out,  and  wrote  : 

I  gather  that  you  have  been  awaiting  a  letter  from  me 
in  regard  to  the  extremely  sad  case  of  your  daughter  whom 
I  saw  last  week  at  Hove.  I  regret  now  therefore  that  I 
did  not  write  to  you,  but  having  in  view  the  fact  that  I 
regarded  the  case  as  one  for  which  unfortunately  nothing 
could  be  done,  and  that  I  expressed  this  view  quite  dis- 
tinctly to  those  who  were  with  the  patient,  I  own  I  rather 
shrank  from  communicating  to  you  personally  an  opinion 
which  I  knew  could  only  cause  you  so  much  pain.  There 
is  just  one  point  further  to  mention.  You  must  allow  me 
to  return  you  the  enclosed  cheque.  I  could  not  possibly 
accept  it  from  one  of  our  Profession,  and  as  it  is  not  my 
privilege  to  be  able  to  help  you  otherwise  in  the  case,  you 
must  at  least  allow  me  this  means  of  showing  my  desire 
to  be  of  service  had  it  been  possible. 

Another  doctor  tells  of  a  case,  near  Birmingham,  of  a  boy 
suffering  from  basal  meningitis  :  the  case  was  hopeless  : 
there  had  already  been  a  consultation,  and  the  doctor  had 
wisely  persuaded  the  boy's  father  not  to  incur  the  further 


270  SIR  VICTOR  HORSLEY 

expense  of  sending  for  Horsley  :  but  one  of  the  family 
telegraphed  for  him.  He  came  at  once,  took  the  position 
of  things  with  infinite  kindness  and  courtesy  to  everybody, 
refused  to  be  paid,  and  went  back  by  a  night  train  :  '  one 
of  the  greatest  men  I  have  known,'  writes  the  doctor, 
'  whose  heart  I  believe  was  the  greatest  part  of  his  greatness.' 

A  lady,  on  whom  he  had  operated  without  payment,  went 
to  see  him  afterwards,  and  offered  him  the  usual  fee  for 
consultation.  '  I  don't  suppose  you  have  been  left  a 
fortune,'  he  said  :  '  when  you  have,  we  can  see  about  fees.' 
A  working-man  brought  his  daughter  to  him,  all  the  way 
from  Wigan.  '  Several  friends  informed  me  that  he  would 
not  spend  more  than  two  minutes  with  me,  and  that  I 
should  not  get  clear  for  less  than  a  fifty  pounds  fee.'  Horsley 
said  that  no  operation  was  needed,  that  the  girl  would  soon 
be  all  right :  then  started  a  talk  on  things  in  general.  '  When 
I  told  him  I  was  a  life-abstainer  and  secretary  of  a  Rechabite 
Tent,  he  was  dehghted,  and  talked  on  for  over  half  an  hour.' 
He  would  not  take  a  fee  :  he  said  that  he  didn't  often  get 
the  opportunity  of  having  a  chat  with  a  working-man. 

Another  working-man,  on  whom  he  operated  at  Queen 
Square  for  cerebral  abscess,  writes,  '  I  cannot  express  in 
words  how  kind  and  generous  he  was  to  me  and  also  my 
friends,  and  with  a  patience  untiring  :  I  am  sure  nothing  I 
can  say  or  do  can  half  express  my  feeling  of  how  grateful 
I  am.  Our  doctor  has  sent  me  a  photo  of  Sir  Victor  which 
I  shall  prize  as  long  as  I  live.' 

Another  letter  describes  his  kindness  to  a  small  child,  on 
whose  head  he  did  two  operations  : 

Children  understood  and  trusted  him  at  once  :  he  never 
chaffed  or  '  talked  down  '  to  them,  and  though  very  gentle 
and  pitiful,  he  was  always  bracing  and  straightforward  ^^^th 
a  young  patient,  and  he  seemed  able  to  really  see  from  the 
child's  point  of  view.  .  .  .  When  a  further  operation  had 
to  be  faced,  he  questioned  the  parents,  *  What  does  the  boy 
remember  about  the  last  time,  and  what  will  he  dread  most  ? 
He  's  a  plucky  little  chap,  and  I  'm  not  going  to  have  him 
frightened.'  When  he  heard  it  was  the  preliminary  pre- 
parations, and  the  anaesthetic,  the  child  would  dread,  he 
reduced  the  former  to  what  could  be  done  by  the  mother 
almost  unaided  ;    and  arranged  that  the  child  should  be 


PRIVATE  PR.\CTICE.    HOME  LIFE       271 

put  to  bed  at  the  usual  hour,  vAth  a  dose  of  trional.  Then, 
an  hour  or  two  later,  he  was  chloroformed  in  his  sleep,  and 
the  operation  took  place  during  the  night,  to  the  great 
inconvenience  of  the  long-suftering  staff  of  the  Nursing 
Home  ;  but  the  child's  peace  of  mind  was  secured.  .  .  . 
When  Sir  Victor  had  time,  and  sometimes  when  he  had 
not,  he  would  sit  down  and  talk  Uncle  Remus  or  Jungle 
Book,  with  the  keenness  of  ten  years  old  and  the  apprecia- 
tion of  a  man  of  letters.  And  who  but  he  knew  the  psycho- 
logical moment  when  a  visit  to  the  Zoo  was  what  a  weary 
little  boy  needed  to  make  life  worth  living,  and  exactly 
where  to  go  when  you  got  there  to  find  the  most  attractive 
beasts,  and  what  to  give  them  to  eat  ? 

Other  letters  describe  what  may  be  called  his  Jungle  Book 
talks  with  grown-ups.  '  Apart  from  his  sympathy  and 
kindness,'  writes  one  patient,  '  his  intense  interest  in  every- 
thing, from  trivial  schoolgirl  incidents  to  suffrage  and 
political  questions,  was  never-ending  and  amazing.'  Another 
writes,  '  Sometimes  he  would  come  into  my  room  in  the 
evening,  and  talk  until  he  was  called  away,  about  temper- 
ance, women's  suffrage,  and  above  all — Home  Rule  !  He 
was  an  ardent  Home  Ruler,  and  I  had  been  brought  up  a 
Unionist,  so  the  argument  was  always  hot.  I  kept  a  photo 
of  Sir  Edward  Carson  in  my  room  :  and  he  would  tell  me 
to  take  it  down,  as  I  "  never  would  get  better  with  him  look- 
ing at  me."  He  was  especially  kind  to  me,  I  think,  because 
I  was  very  young  and  very  Irish  !  He  would  listen  for  ages 
to  stories  of  the  peasants  and  country  people.' 

If  a  patient  did  not  really  need  him,  and  was  in  good 
hands,  and  was  doing  well,  he  would  take  his  leave  so  soon 
as  he  could  :  and  he  sometimes  gave  offence  in  this  way. 
It  looked  like  indifference  or  neglect :  it  was  neither  :  it 
was  the  natural  result  of  his  confidence  in  his  assistant,  or 
in  the  practitioner,  or  in  the  nurse,  to  whom  he  entrusted 
the  case  :  he  knew  that  they  would  let  him  know  at  once, 
if  he  were  really  needed  :  and  he  made  it  his  business  not 
to  interfere  with  them,  but  to  keep  in  touch  with  them.  It 
was  not  in  him,  to  be  thoughtless  of  cases.  To  somebody 
who  was  praising  the  scenic  effects  of  London,  he  answered 
that  he  never  noticed  them  ;  that  he  was  thinking  of  his 
patients. 


272  SIR  VICTOR  HORSLEY 

It  was  said  of  him  that  he  was  hard  and  inconsiderate 
toward  nurses.  One  of  his  patients  writes,  '  I  had  never 
seen  him,  and  thought  he  would  be  very  fierce  and  alarming. 
I  must  say  the  way  he  spoke  to  the  nurses  confirmed  me 
in  this  idea.'  But  a  nurse  who  worked  for  him  for  fourteen 
years  in  a  Nursing  Home  is  able  to  speak  with  authority  on 
this  point.  She  says  that  he  may  have  been  hard  on  nurses 
who  perhaps  only  saw  him  once  or  twice,  and  did  not  under- 
stand his  ways  ;  that  of  course  he  had  ways  of  his  own  at 
an  operation  ;  he  insisted  that  all  who  were  taking  part  in 
it  should  work  well  together  :  but  he  was  not  hard  on  any 
nurse  who  understood  his  ways  ;  and,  so  soon  as  the  strain 
of  the  operation  was  over,  he  would  be  courtesy  itself.  The 
same  is  said  by  a  surgeon  who  knew  him  intimately  :  that 
he  would  get  an  idea  that  a  nurse  had  made  a  mistake,  and 
from  that  time  he  would  not  have  a  good  word  for  her  ;  she 
would  be  '  not  a  good  nurse  '  ;  and  if  he  were  in  a  mood  of 
irritation,  he  might  speak  roughly  to  her  :  but  when  he 
knew  and  trusted  a  nurse,  he  would  be  charming  to  her. 

In  his  practice,  he  was  quick  to  accept  any  suggestion, 
if  it  were  carefully  put  to  him  ;  but  he  had  to  be  '  approached 
the  right  way.'  If  that  were  done,  '  it  was  so  easy  to  get 
him  to  see  your  point  of  view,  that  he  would  even  carry  it 
further  ;  and  what  you  had  meant  as  a  suggestion  was 
taken,  at  last,  as  a  sort  of  order.' 

He  never  boasted  of  his  power  of  diagnosis  and  his 
dexterity  in  operating  :  indeed,  he  rather  made  light  of 
them :  he  said  that  '  anybody  could  acquire  manual  dex- 
terity '  :  and  he  sought  to  encourage  other  men  by  attribut- 
ing his  success  to  the  fact  that  he  hved  in  Cavendish  Square. 
To  a  surgeon  starting  in  consulting  practice,  he  said,  '  Now, 
my  dear  boy,  I  '11  give  you  a  bit  of  advice.  Mind  you  start 
in  the  right  place  :  I  started  in  Gower  Street  :  that  was  a 
great  mistake.  Since  I  moved  to  Cavendish  Square,  I  've 
had  nothing  to  complain  of.'  He  would  have  achieved 
success,  even  if  he  had  put  up  his  name  at  the  base  of  the 
Monument  and  lived  in  the  cage  on  the  top. 

But  his  practice  fell  off  miserably,  during  the  four  or  five 
years  before  the  War.     Partly,  the  medical  men  who  thought 


PRIVATE  PRACTICE.     HOME  LIFE       273 

that  he  had  '  betrayed  '  them  over  the  Insurance  Act  were 
unwiUing  to  send  patients  to  him.  Partly,  it  was  said  that 
he  was  giving  up  practice.  Partly,  there  were  invalids 
who  so  disliked  his  politics  that  they  preferred  another 
surgeon  :  indeed,  one  medical  man,  who  had  been  in  the 
habit  of  asking  for  consultations  with  him,  said  now  '  that 
his  patients  objected.'  It  was  natural  enough,  after  1910, 
that  strangers  to  him,  who  were  fearing  the  possibihty  of 
an  operation,  should  hesitate,  thinking  him  '  immei-sed  in 
pohtics.'     He  writes  to  a  friend,  Jan.  1913  : 

I  only  saw  your  kind  letter  about  the  boycott  yesterday. 
As  regards  the  general  thing  itself  you  are  probably  correct. 
What  of  course  is  more  militant  against  my  doing  more 
practice  is  the  report  being  industriously  circulated — and 
reached  me  to-day — that  I  am  retiring  from  practice.  This 
of  course  I  have  known  a  long  time  would  be  done,  as 
indeed  it  was  when  I  resigned  Univ.  Coll.  Hosp.  six  years 
ago.  As  regards  the  second  point,  namely  that  my  surgery 
is  mediaeval,  that  of  course  is  possible,  and  to  avert  the 
true  part  of  that  I  shall  not  operate  after  sixty.  This  I 
decided  long  ago.  Doubtless,  also,  it  will  choke  off  work. 
We  must  just  see. 

Under  the  unhappiness,  illness,  and  overstrain  of  these 
years,  he  would  have  broken  down,  if  it  had  not  been  for 
his  home-life.  All  of  us  saw  the  side  of  him  that  he  faced 
the  world  with  :  but  those  of  us  who  did  not  see  the  other 
side  of  him,  the  home-life,  did  not  know  him.  Indeed,  it 
was  perfect  :  it  was  the  making  of  him  and  the  saving  of 
him.  Not  that  it  was  leisurely  :  it  was  incessantly  strenu- 
ous :  it  drove  ahead,  every  day  and  all  day  long,  toward  the 
attainment  of  a  hundred  purposes.  He  and  his  wife  were 
of  one  mind  in  contempt  for  whatever  things  are  second-rate, 
sham,  selfish,  or  wasteful  of  time  or  thought :  they  planned 
their  life,  and  they  lived  it,  above  all  idolatry.  For  many 
years  they  refu.scd  invitations  to  dinners  and  evening  parties 
— which  then  were  frequent  and  ostentatious  in  London, 
and  not  least  in  the  neighbourhood  of  Cavendish  Square  ; 
they  did  not  go  to  a  theatre  more  than  once  or  twice  a  year  : 
and  when  the  fashion  for  week-ends  was  invented,  they  did 
not  follow  it.     The  evenings  were  for  work.     He  read  hard  ; 

s 


274  SIR  VICTOR  HORSLEY 

no  man  in  his  profession  was  better  acquainted  with  the 
science  and  practice  of  his  own  and  other  countries.  As  he 
used  to  say,  '  I  hate  having  to  say  "  I  don't  know."  '  He 
had  the  rare  gift  of  enjoying  to  work  with  his  family  round 
him  :  one  of  his  friends  writes  of  '  his  power  of  being  able 
to  "  concentrate  "  on  many  things  simultaneously  :  prac- 
tically all  his  writing  was  done  in  his  drawing-room,  with 
all  sorts  of  distractions  ;  yet  he  could  write  a  paper,  dictate 
letters,  discuss  sociology  and  politics,  and  play  with  his 
little  fox-terrier,  almost  in  the  same  moment.'  On  Sundays, 
if  his  work  and  his  popular  lecturing  would  let  him,  his 
favourite  place  was  the  Zoological  Gardens.  He  was  not  only 
a  naturalist,  he  was  a  bom  lover  of  animals  :  the  instinctive 
understanding  between  him  and  them  was  perfect.  There 
was  an  amusing  example  of  it,  during  the  trial  of  the  '  brown 
dog'  case,  November  1903:  a  cat  found  its  way  into  the 
Court,  disregarded  the  supporters  of  anti-vivisection,  went 
to  Horsley,  and  sat  on  his  knee  with  evident  pleasure. 

What  is  far  more,  he  was  a  devout  lover  of  children,  and 
had  wonderful  influence  over  them.  A  young  nephew  of 
his,  on  naval  medical  service  during  the  War,  wrote  home, 
on  the  news  of  his  death  : 

All  yesterday  I  went  about  in  a  sort  of  dream  :  I  really 
don't  know  what  happened  at  all.  It  seemed  impossible  : 
and  yet,  you  know,  I  felt  that  he  wouldn't  come  back  again 
—  from  the  first  —  I  don't  know  why  —  but  I  somehow 
imagined  that  for  the  first  time  in  his  life  he  had  under- 
taken something  beyond  his  strength,  and  that  he  would 
not  be  able  to  see  it  through,  even  he.  As  a  small  boy  I 
used  to  idoHse  him  in  my  own  mind  as  almost  a  god.  His 
figure  and  agility  and  youth  and  health,  on  the  physical 
side  ;  and  his  amazing,  consummate  genius  ;  and  his  effort- 
less— or  wliat  seemed  effortless — way  of  tackling  things 
with  almost  complete  success  in  the  medical  or  scientific 
world  ;  and  then  his  astounding  sense  of  duty  in  every- 
thing he  did  ;  and  his  radiant  kindness.  I  really  don't 
know  anybody  who  excited — or  rather  intoxicated — me 
from  my  earliest  boyhood,  like  he  did.  I  remember,  every 
time  he  used  to  pay  a  flying  visit  to  the  Lawn  in  the  old 
days,  how  I  used  to  count  the  minutes  I  spent  in  his  pres- 
ence, and  how  I  used  to  treasure  every  word  he  said  :  I 
repeated  his  name  over  and  over  again,  then,  which  thrilled 


PRIVATE  PRACTICE.     HOME  LIFE       275 

me.  He  seemed  to  me  immortal  in  a  sort  of  way.  Nothing 
was  apparently  beyond  his  reach.  I  couldn't  have  borne 
it,  seeing  him  getting  old. 

That  is  what  he  was  to  the  generation  which  comes  after 
him.  A  letter  from  Dr.  Flemming,  of  Bradford-on-Avon, 
tells  what  he  was  to  a  friend  of  his  own  age  : 

I  found  him  one  day,  not  long  before  the  War,  in  his 
drawing-room ;  several  dozen  lantern-slides  spread  on  a 
table  ;  he  was  arranging  them  for  a  lecture  on  the  Great 
Roman  Wall  across  England,  that  he  was  to  give  at  some 
society  next  evening  :  he  had  taken  the  photographs  him- 
self, and  years  before  had  taken  part  in  excavating  some 
of  the  Wall.  Wliile  we  talked,  he  ate  his  simple  meal  of 
eggs  and  bread  and  butter  and  tea,  excusing  himself  as  he 
had  to  go  soon  to  speak  at  a  meeting  of  some  society  that 
dealt  %\ith  the  abuses  of  ground  landlords.  It  came  out 
that  the  night  before  he  had  been  in  Oxford  lecturing  on 
early  brain-surgery  ;  and  had  taken  the  opportunity  while 
there  to  address  undergraduates  on  temperance.  We  talked 
of  the  coming  Aberdeen  meeting  of  the  B.M.A.,  and  of 
matters  of  medico-political  interest  to  be  discussed  there  ; 
and  he  told  me  that  when  he  returned  from  his  hoUday 
he  was  going  by  invitation  to  Vienna,  to  open  a  discussion. 
He  also  asked  me  if  I  could  find  out  about  a  xiv.  century 
castle  near  Frome,  Somerset — if  they  were  going  to  raise 
money  to  keep  it  in  repair,  as  he  would  like  to  help. 

What  always  struck  me  so  much,  apart  from  his  personal 
charm  and  fascination  and  his  genius  for  friendship,  was 
his  extraordinary  capacity  for  finding  time  and  thought 
for  every  friend.  I  was  only  one  of  hundreds,  quite  as  it 
were  a  casual  friend,  but  he  would  find  time  for  long  con- 
versations, to  drive  me  to  the  station,  to  spend  a  whole 
Sunday  afternoon  at  the  Zoo — can  one  imagine  a  more 
delightful  visit  there  than  with  Horslcy,  his  knowledge  of 
comparative  anatomy  and  of  the  habits  and  characteristics 
of  animals,  his  evident  love  for  everything  living  ? 

What  wonder  that  he  inllucnccd  the  lives  and  thoughts 
of  men,  and  their  outlook  on  life.  I  doubt  whether  yet  the 
profession,  especially  general  practitioners,  realise  how  hard 
he  fought  for  them,  how  much  he  did  for  them.  At  a  time 
when  men  were  growing  dissatisfied  with  the  B.M.A.,  and 
complaining  tliat  it  was  too  much  managed  by  consultants, 
here  was  a  consultant  par  excellence  figliting  for  the  control 
of  the  Association  by  the  general  practitioner,  fighting  then 
as  he  after\vards  did  nbout  the  Insurance  Act,  absolutely 
regardless  of  iiis  own  uitcrcbts. 


276  SIR  VICTOR  HORSLEY 

How  did  he  ever  manage  to  be  disliked,  he  who  was 
made  to  be  admired  ?  Envy  had  not  much  to  do  with  it : 
envy  and  admiration  can  well  keep  house  together.  No- 
body could  help  env}dng  him.  How  was  it  that  anybody 
could  help  liking  him  ? 

Some  of  us,  members  of  his  profession,  were  more  solemn 
than  we  needed  to  be  in  our  dislike  of  his  vehemence,  his 
displayed  contempt  for  the  other  man's  point  of  view.  This 
of  all  faults  has  least  chance  of  hiding  itself :  and  in  him 
we  ought  not  to  have  taken  it  so  tragically.  We  wanted 
him  to  be  like  the  rest  of  us,  and  that  is  just  what  he  was 
not.  We  could  be  content  with  compromises  and  measures 
of  expediency  :  he  could  not  :  his  motto  should  have  been 
Brand's  intolerable  text.  All  or  nothing.  He  despised 
expediency,  he  believed  in  principles.  He  did  not  hold 
with  letting  things  slide,  nor  with  dismissing  them  un- 
examined. If  a  phrase  in  a  letter  vexed  him,  he  would  be 
inclined  to  '  have  it  out '  with  the  writer,  and  would  even 
lecture  him  in  a  correspondence  of  steadily  growing  ex- 
asperation on  both  sides.  Some  whom  he  offended  were 
his  seniors,  men  of  high  standing :  he  would  speak  out  his 
mind  as  it  were  ex  cathedra,  he  would  even  give  the  cut 
direct  :  it  was  inevitable,  that  they  should  resent  his 
behaviour  to  them  :  they  had  reason  enough  for  saying 
that  he  was  '  dillicult  to  work  with.' 

But  the  young  men  who  worked  with  him  in  Hospital 
wards  and  physiological  laboratories  did  not  find  him 
difficult  to  work  with  :  they  found  him  keen  to  help  them, 
lavish  of  his  gifts,  enjoying  to  advise  and  guide  them  in 
their  work  so  that  it  should  tell  to  the  best  advantage  not 
for  him  but  for  them.  And  they  are  but  a  few  of  the  many 
of  us  whom  he  greatly  helped.  Let  alone  all  the  consult- 
ing and  operating  that  he  did  for  love  not  for  money,  he 
was  always  generous  if  a  gift  of  money  were  needed  and 
deserved.  And  there  are  men  whom  he  stood  by  and 
befriended,  year  in  year  out,  with  steady  personal  kind- 
ness, seeing  them  through  one  perplexity  after  another. 

Besides,  though  he  was  quick  to  take  and  to  give  offence, 
he  did  not  set  himself  to  enlist  on  his  side,  either  in  pro- 


PRIVATE  PRACTICE.    HOME  LIFE       277 

fessional  or  in  general  politics,  those  of  us  who  were  non- 
combatants  :  there  are  many  who  can  look  back  over 
thirty  years  of  constant  friendship  with  him,  though  he 
and  they  were  never  agreed  in  poUtics,  nor  ever  desired  to 
be  agreed. 

Besides,  some  of  us  found  offence  where  none  was  intended ; 
we  took  seriously  his  hght  use  of  flamboyant  words,  which 
were  nothing  more  than  the  slang  of  his  early  years  ;  mock- 
heroic  epithets,  to  be  let  off  hke  fireworks.  He  would  call 
So-and-so  a  ruffian  or  an  arch-liar  or  a  scoundrel ;  saying  it 
with  a  smile  and  a  good-natured  shrug  of  the  shoulders, 
or  digging  his  hands  into  his  pockets  and  throwing  back 
his  head  and  laughing  at  the  bare  image  of  the  man.  It  was 
habit :  there  are  scoundrels  in  a  letter  of  1881,  and  ruffians 
on  a  postcard  of  1882.  The  trouble  was,  that  So-and-so 
would  not  be  aware  of  that  :  he  would  only  hear  that 
Horsley  had  caUed  him  a  scoundrel. 

The  fact  remains,  that  he  alienated  men  whom  he  could 
just  as  easily  have  bound  to  himself  in  friendship.  He  was 
not — in  the  deepest  sense  of  the  phrase — a  good  judge  of 
men.  A  physician  or  a  surgeon,  by  the  exercise  of  his 
calling,  becomes  a  good  judge  of  those  men  and  women 
whom  he  attends  ;  he  sees  them  under  conditions  of  sin- 
cerity and  of  confidence,  and  sometimes  of  pitiful  disclosure ; 
he  is  perpetually  learning  from  them  :  but  he  may  fail 
to  be  a  good  judge  of  people  who  have  nothing  the  matter 
with  them.  Horsley  understood  his  patients,  with  insight, 
sympathy,  and  gentleness  :  but  he  did  not  so  well  under- 
stand his  opponents.  We  are  told  that  we  must  observe 
the  distinction  between  the  sin  and  the  sinner  :  it  is  not 
so  easy  as  it  sounds  :  and  he  did  not  care  to  trouble  himself 
over  it.  If  he  disUkcd  a  hne  of  action,  he  tended  to  dislike 
the  man  who  was  taking  it ;  and  sometimes  would  try  to 
defeat  him  with  heavy  sarcasm.  The  action  was  the  man. 
The  action  being  '  criminal  '  or  '  immoral,'  there  must  be 
something  wrong  with  the  man. 

This  inability  to  '  honour  all  men  '  was  nothing  to  us,  so 
long  as  it  remained  inside  the  sphere  of  professional  affairs, 
in  comparison  with  his  achievements.     None  of  us  could 


878  SIR  VICTOR  HORSLEY 

do  his  work  or  take  his  place.  But  in  the  later  years,  when 
he  carried  his  vehemence  into  pubhc  hfe,  we  had  some 
excuse  for  looking  solemn.  Our  admiration  of  him  was 
baulked  by  what  he  was  saying  in  the  press  and  on  the 
platform :  we  took  it  amiss — '  we  that  had  loved  him  so, 
followed  him,  honoured  him  ' — that  he  was  at  the  mercy 
of  the  newspapers. 

He  might  well  have  borne  himself  more  quietly.  For 
what  he  was  doing  was  something  new,  which  the  rest  of 
his  profession  was  not  doing.  He  was  '  creating  a  pre- 
cedent '  :  and  as  he  created  it  in  his  own  image,  it  was  '  a 
dangerous  precedent.'  He  was  abandoning  the  stately  old 
idea,  that  a  medical  man  should  avoid  pubhcity  and  be 
content  with  practice.  Against  this  old  idea,  he  set  his 
new  idea,  that  a  medical  man  is  just  as  free  as  any  other 
man  to  fling  himself  into  open  poUtical  warfare,  and  to 
fight  for  any  cause  which  appeals  to  him.  The  great 
physicians  and  surgeons  of  the  generation  before  him  upheld 
the  old  idea.  They  kept  themselves  to  themselves.  They 
were  afraid  of  seeming  to  advertise,  and  they  were  afraid 
of  lowering  the  tone  of  the  profession.  They  did  not  care 
to  go  outside  the  happiness  that  they  found,  and  the  good 
that  they  did,  in  science  and  practice. 

Now  and  again,  they  were  afraid  where  no  fear  was  :  they 
would  have  been  more  useful  to  the  community,  on  this  or 
that  occasion,  if  they  had  spoken  out  what  was  in  their 
minds,  and  had  published  it  far  and  wide.  But  they  were 
held  back,  not  only  by  dislike  of  pubhcity,  but  by  the  sense 
that  the  pubhc  did  not  understand  either  their  science  or 
their  practice.  Why  should  they  talk  to  it  about  things 
which  it  could  not  imderstand  ?  When  they  did  handle 
politics — what  one  of  the  greatest  of  them  called  '  these 
beastly  poUtics  * — they  preferred  the  indirect  method :  they 
approached  the  Government  by  a  circuitous  path,  as  if 
they  were  stalking  it.  They  obtained  some  good  results  : 
but  it  WcLS  a  slow  business.  Their  interests  were  repre- 
sented, more  or  less,  in  Parliament ;  but  it  cannot  be  said 
that  their  representatives  were  dominant  figures. 

Times  are  changed  :  and  the  medical  profession  is  learn- 


PRIVATE  PRACTICE.     HOME  LIFE      279 

ing,  rather  painfully,  to  adapt  itself  to  the  change.  We  are 
more  willing  now  to  educate  our  masters,  and  to  throw  in 
our  lot  with  them.  Even  before  the  War,  some  of  us  were 
at  work  on  the  new  lines  :  but  Horsley  was  ahead  of  us  : 
he  had  '  gone  in  for  pohtics,'  he  was  scattering  the  past 
about,  hke  the  New  Age  in  Matthew  Arnold's  poem.  Through 
the  difficult  years  which  are  coming,  whatever  public  duties 
may  be  required  of  our  profession,  it  was  Horsley  who  gave 
us  a  lead  in  the  years  before  the  War. 

One  more  criticism  remains  to  be  considered,  not  of  his 
work  in  pohtics,  but  of  his  work  in  physiology  ;  that  he 
was  impatient  for  results  ;  that  he  ought  to  have  made 
fewer  experiments,  and  to  have  observed  them  more  labori- 
ously ;  that  he  did  not  attain  Pasteur's  ideal  of  a  man  of 
science,  who  '  must  compel  himself  to  fight  against  himself, 
for  days,  weeks,  perhaps  years  ;  to  try  to  defeat  his  own 
experiments  ;  and  not  to  proclaim  his  discovery  till  he  has 
exhausted  all  other  possible  theories.'  But  he  followed, 
early  in  life,  three  great  and  well-marked  Hues  of  scientific 
research  :  on  the  locahsation  of  function  in  the  brain  and 
cord,  on  myxoedema,  and  on  rabies.  This  threefold  work, 
1884-1893,  was  all  of  it  early  work  :  the  latest  of  it  is  a 
quarter  of  a  century  old.  Like  all  research  in  the  natural 
sciences,  it  had  to  be  corrected  here  and  there.  He  took  up 
each  subject  at  the  decisive  moment ;  in  the  nick  of  time. 
Everywhere  men  were  talking  of  cerebral  locahsation,  the 
thyroid  gland,  and  the  protective  treatment  against  rabies. 
He  comes  in  at  the  topmost  height  of  our  expectations. 
The  adjustment  of  surgery  to  the  physiology  of  the  brain 
and  cord,  the  discovery  of  the  action  of  the  thyroid  gland, 
the  stamping  out  of  rabies  and  hydrophobia — all  these  we 
were  hoping  for,  and  were  looking  to  him  to  help  us  toward 
them.  Nobody  can  say  that  he  failed  us.  Nobody  denies 
the  authority  and  the  staying  power  of  his  work  for  science 
and  practice.  He  is  with  Ambroise  Par6,  Lister,  and 
Hunter  :  with  them,  not  below  them.  Par^,  in  practice, 
was  one  of  the  greatest  of  all  surgeons  ;  but  he  had  only 
such  science  as  the  age  could  give  him.  Lister  is  greatest 
of  all  the  '  saints  laiques  '  in  the  doctor's  calendar  ;    but 


280  SIR  VICTOR  HORSLEY 

he  docs  not  equal  Horsley  in  range  and  imaginative  insight. 
Hunter  was  magnificent :  but  he  did  not  trouble  himself 
over  the  welfare  of  the  community  :  he  was  content  with 
a  rather  selfish  hfe. 

That,  after  all,  is  the  distinctive  note  of  Horsley's  hfe  and 
work  ;  that  he  could  not  rest  in  all  science  and  practice, 
but  must  also  be  in  pohtics.  We  have  lost  a  man  who  was 
always  willing  to  set  aside  his  own  interests  for  the  whole- 
hearted, full-blooded  pursuit  of  an  unpopular  cause.  We 
had  been  with  him,  followed  him,  or  come  into  coUision 
with  him  in  the  streets  of  hfe,  always  conscious  of  him, 
always  saying  that  there  was  nobody  hke  him  :  and  then 
of  a  sudden  he  was  gone,  and  we  were  left  standing  on  the 
old  ways  of  individualism,  honourable  but  unad venturous. 

If  it  were  possible  to  put  him  in  a  sentence,  he  had  the 
supreme  gift  of  dehght  in  the  use  of  all  his  gifts.  He  seemed 
never  to  be  idle,  never  slack  or  vague  or  at  a  loss  for  some- 
thing to  work  at  or  admire  or  fight  for.  It  is  the  secret  of 
our  envy  of  him,  that  he  was  heart  and  soul  in  love  with 
life.     That  is  why  his  death  so  took  the  colour  out  of  things. 

Like  Ajax  raging  to  himself  in  his  tent,  and  mistaking  a 
flock  of  sheep  for  his  enemies,  he  was  unwise  in  his  wrath, 
and  would  attack  harmless  people  with  strange  misunder- 
standing of  them.  He  bewildered  and  exasperated  us  :  he 
shook  us  up  :  he  shone  us  down.  It  all  comes  back  to  the 
phrase  that  there  was  nobody  hke  him  :  as  it  was  said  of 
him,  at  some  German  festival  dinner,  '  Und  da  steht  Horsley 
wie  ein  Gott.'  One  can  hardly  imagine  him  in  old  age,  slow 
and  infirm  and  past  work :  he  did  not  have  to  face  it. 

When  he  died,  he  was  nearing  the  end  of  his  inventive 
and  imaginative  power  in  physiology  and  in  surgery.  He 
said,  not  long  before  the  War,  to  one  who  complained  that 
he  was  giving  up  science  for  politics,  '  It 's  all  very  well ; 
but  my  brain  's  not  boiling  with  ideas  as  it  was  when  I  was 
thirty.'  Some  time  after  1914,  he  said  to  his  daughter  that 
he  was  losing  his  keenness  for  research  ;  that  it  did  not  stir 
him,  when  younger  men  talked  to  him  of  what  they  were 
doing.  His  hfe  was  beginning  to  tell  on  him.  Always,  he 
had  taken  the  responsibihty  of  advising  and  treating  those 


PRIVATE  PRACTICE.    HOME  LIFE        281 

who  were  nearest  and  dearest  to  him,  even  operating  on 
them  :  it  will  never  be  known,  save  to  one  or  two,  what  a 
strain  some  of  these  cases  put  on  him.  If  he  had  come  back 
from  Mesopotamia,  he  would  have  devoted  himself  to  the 
pohtical  advancement  of  national  happiness  and  health 
and  efficiency,  and  would  have  done  more  than  any  man  in 
his  profession  was  doing. 

He,  and  he  alone,  had  the  planning  of  his  hfe  :  we  had 
designs  of  our  own  for  him  :  but  he  alone  decided  how  to 
use  up  all  that  was  in  him.  Always,  he  had  spent  himself 
with  superb  extravagance  :  he  was  still  at  work,  the  day 
before  he  died.  It  is  not  in  the  range  of  men's  intellects, 
to  understand,  through  and  through,  a  man's  hfe.  The 
real  values  of  it  are  hid  from  them,  and  are  not  clear  even 
to  him.  This  man,  at  any  rate,  played  his  hfe  for  all  it 
was  worth  :  there  is  nothing  that  he  kept  back  from  us, 
there  is  nothing  that  he  feared. 


PART    III 
DURING    THE    WAR 

I.  LONDON.      WIMEREUX 
II.  EGYPT 
III.  INDIA.     MESOPOTAMIA 


e 


I'liiito  S/<ciiii!lil.  I.ditilon 


SIR     VICTOR     HORSLEY. 


London.    Wimereux 

On  the  Monday,  August  3,  1914,  he  had  occasion  to  write  to 
friends  in  Berlin,  who  were  looking  after  one  of  his  patients  ; 
the  letters  came  back  '  Undehverable,'  and  were  put  away  ; 
they  are  concerned  with  the  treatment  of  the  case,  but  he 
states  in  them  his  first  thoughts  of  the  War  : 

(i)  Of  course  I  think  it  is  wholly  unjustifiable,  though  I 
appreciate  that  Austria's  difficulty  in  keeping  order  in  the 
Balkan  States  must  be  very  great.  Still  I  do  not  think 
that  she  should  have  begun  war,  for  it  was  obvious  the 
whole  of  Central  Europe  would  start  in.  As  to  Russia,  no 
one  detests  Russia  and  all  her  ways  more  than  I  do,  and 
it  is  most  disturbing  to  feel  that  in  any  way  directly  or 
indirectly  one  is  helping  Slav  barbarism.  My  only  hope 
now  is  that  the  people  of  each  nation  will  rise  and  stop  the 
whole  gang  of  Chancellors  and  Emperors  by  wiping  them 
off  the  scene.     But  I  fear  the  millennium  is  too  far  off  as  yet. 

(2)  Until  the  officials  are  under  the  power  of  the  whole 
people,  men  and  women,  this  stupid,  insane  folly  of  war 
must  go  on.  I  can  only  hope  that  as  after  1870,  Socialism 
will  get  more  strength  and  put  an  end  to  the  arbitrary 
miseries,  injuries  and  losses  heaped  on  millions  of  people 
by  their  rulers.  I  remember  well  in  Berlin  in  1890  Virchow 
made  a  speech  at  a  small  dinner  I  was  at,  when  he  spoke  of 
the  Russian  danger  to  Germany,  and  how  it  could  only  be 
opposed  really  by  the  German  people  receiving  pohtical 
liberty.  Of  course  so  far  he  was  right,  and  I  trust  that  this 
will  be  the  result  of  the  war. 

He  was  too  ready  with  his  judgment.  It  is  true  that  he 
saw,  and  said  in  public,  that  a  state  of  war  brings  out  fine 
qualities  in  men  ;  he  loved  to  praise  the  mind  of  Abraham 
Lincoln  ;  and  much  that  he  foretold  has  already  come  true. 
But,  if  we  are  to  go  by  his  letters,  he  wrote  of  the  War,  and 
of  all  war,  as  stupid  murderous  folly,  a  sort  of  criminal 
insanity  brought  upon  a  nation,  somehow,  by  tyrants  and 


286  SIR  VICTOR  HORSLEY 

diplomatists,  a  madness  to  be  cured  by  democracy  and 
universal  suffrage.  He  is  so  confident  of  his  ability  to  judge 
the  War,  that  he  does  not  realise  how  the  War  is  judging 
him.  There  is  next  to  nothing,  in  his  letters,  about  the 
War  and  the  nations,  that  rises  above  contempt  and  invec- 
tive phrases  :  one  longs  for  something  else — the  Greeks  had 
a  word  for  our  proper  attitude  in  the  presence  of  the  Gods — 
some  confession  of  faith,  humility,  ignorance :  something 
to  redress  the  balance. 

There  is  a  letter  of  a  very  different  sort,  a  curiosity  of  the 
War ;  it  came  to  him  from  Germany,  a  few  weeks  later  ; 
a  good  typewritten  example  of  stock  letter-writing  ;  doubt- 
less from  an  old  patient,  for  it  is  signed  Yours  very  grate- 
fuUy: 

Although  by  this  unnatural  war  all  confidence  has  been 
destroyed  between  our  two  nations  I  feel  that  even  now  an 
English  gentleman  will  believe  the  word  of  a  German  gentle- 
man. I  uill  put  some  facts  before  you  and  on  my  word  of 
honour  declare  them  to  be  true.  Our  German  soldiers  have 
not  shot  a  single  Belgian  civilian  nor  burnt  a  single  Belgian 
house  unless  by  order  of  their  superiors  to  punish  outrages 
unheard  of  in  the  history  of  modem  European  warfare 
although  not  unknown  in  the  Belgian  Kongo. 

Belgian  men,  women  and  children  have  murdered  German 
soldiers  peacefully  sleeping  in  their  houses  and  coaxed  into 
security  the  evening  before.  They  have  cut  out  the  eyes 
of  the  wounded,  mutilated  them,  shot  nurses  and  doctors. 

The  town  and  population  of  Loewen  [Louvain]  was  not 
touched  until  the  Gennan  garrison  was  fired  on  by  the 
whole  civilian  population.  Then  there  was  a  fight  and  after 
the  fight  the  whole  population  was  ordered  out  of  the  town 
and  fire  put  to  many  houses.  Nevertheless  when  by  order 
of  their  superiors  our  soldiers  were  busy  extinguishing  the 
fire  to  protect  the  town  hall  they  were  again  fired  on. 

Many  thousands  Dum  Dum  bullets  have  been  found  in 
the  pockets  of  many  French  soldiers,  they  were  of  French 
make  and  obviously  manufactured. 

It  is  not  true  that  the  Russians  are  progressing  in  Germany, 
we  have  beaten  them  in  a  decisive  battle  on  the  29th  of 
August,  and  made  90,000  prisoners ;  in  the  last  three  days 
we  have  won  another  great  victory  and  now  there  are  prac- 
tically no  more  Russians  on  this  side  of  the  frontier. 

He  had  been  a  Captain  in  the  Territorial  Force  since 
1910,  and  was  on  the  Staff  of  the  3rd  London  Hospital ; 


LONDON.    WIMEREUX  287 

he  worked  hard  for  its  organisation  and  equipment,  so  soon 
as  war  was  declared  ;  but  of  course  he  was  longing  for 
more  active  work  :  he  was,  as  he  afterwards  said,  '  eating 
his  heart  out  at  home  in  enforced  idleness  ' :  and  he  tried  all 
possible  means  to  put  his  services  at  the  disposal  of  the  sick 
and  wounded.  On  August  12,  he  writes  to  Sir  Arthur 
Sloggett  : 

As  I  am  extremely  anxious  to  serve  in  the  present  War,  is 
it  not  possible  for  me  to  be  transferred  to  the  Active  Ser\ace 
List,  and  given  an  appointment  as  Surgeon  to  a  Base  Hospital 
either  in  England  or  on  the  Continent  ?  I  will  wait  on  you 
to-morrow  at  the  War  Office  on  the  chance  of  your  being 
able  to  see  me.  I  may  say  I  have  my  kit,  and  could  leave 
at  once. 

He  was  advised  not  to  ask  for  immediate  transference. 

A  few  days  later,  he  writes  again  : 

I  venture  to  hope  that  you  may  think  it  weD  to  form  a 
group  of  supernumerary  officers,  attached  to  the  Expedi- 
tionary Force,  and  at  the  disposition  of  the  Principal  Medical 
Officer  of  that  Force,  in  order  that  he  might  supplement  the 
estabHshment  of  any  base  hospital  upon  which  special 
pressure  of  work  happened  to  fall.  This  would  not  in  any 
way  mean  the  appointment  of  a  special  group  of '  consultants,' 
a  course  which  has  always  seemed  to  be  contrary  to  Service 
organisation  and  discipline.  On  the  other  hand,  the  appoint- 
ment of  supplementary  officers  would  not  only  augment 
the  general  surgical  staff  when  required,  but  also,  if  desired, 
add  to  the  consultant  strength.^ 

On  August  25,  he  writes  to  Dr.  Lendon  of  Adelaide  : 

The  situation  is  exactly  what  you  would  expect  from  the 
aristocrats  who  rule  Europe.  Austria  tr^-ing  to  smash 
Servia :  Germany  coolly  smashing  Belgium.  Burglary 
and  murder  arranged  in  the  name  of  God  by  rulers  and 
nobles.  And  all  the  while  the  people  who  are  starved, 
tortured,  and  killed  have  not  liad  a  single  voice  in  the  matter  I 


'  To  Dr.  Mary  Slurge,  Aug.  17. — '  Clearly  we  can  push  forward  now  [with 
the  fifth  edition  of  Alcohol  and  the  Human  Body],  though  it  is  really 
very  difficult  to  work  with  any  ko  or  purjKjse  when  one  is  quite  certain 
that  one  could  really  be  of  much  more  service  elsewhere,  vis.  in  the 
Belgian  base  hospitals.  However,  I  am  not  going  out  in  any  of  these 
fashionable  and  disreputable  sideshows,  I  am  glad  to  say.  Moreover,  as 
a  T.F.  otTicer,  the  War  OfTire  have  the  determination  of  my  movements, 
n  they  agree  to  my  application  to  be  transferred  from  the  T.F.  to  the 
active  service  list,  I  would  probably  be  off  somewhere  aUiuf  Sept.  i, 
I  suppose,  but  I  am  doubtful  how  far  my  innumerable  haters  will  succeed 
in  dishing  my  application  altogether.' 


288  SIR  VICTOR  HORSLEY 

The  worst  is  that  the  people  generally,  and  especially  the 
Germans,  are  not  civihsed,  and  are  so  uneducated  pohtically 
that  they  are  like  sheep,  and  I  doubt  really  whether,  when 
all  this  mad  folly  is  over,  they  will  claim  democratic  and 
parliamentary  Government.  If  they  do  not,  then  all  the 
same  rotten  expenditure  on  armaments  and  fleets  and  '  glory  ' 
will  go  on  just  as  before,  and  in  another  fifty  years  there 
will  be  another  turn-up  of  the  same  kind.  Of  course  we 
must  simply  now  keep  the  pot  boiling  until  the  Germans 
have  evaporated  to  dryness,  or  life  will  not  be  worth  having 
for  anybody  anywhere.  Siward  and  Oswald  being  in  the 
Teiritorials  and  I  in  the  Territorial  Medical  Service,  we 
chucked  our  hohday  on  mobiUsation,  and  came  back  here 
to  remain.  My  base  hospital  having  a  staff  twice  too  large, 
and  my  seniors  having  started  first  with  the  posts,  I  have 
volunteered  for  the  Expeditionary  Force  in  France,  but 
doubt  whether  they  will  appoint  any  Supernumerary  Officers 
yet.  However,  my  name  is  down  first  to  be  employed  from 
the  Territorial  Force,  so  if  I  am  not  appointed  it  will  be  the 
usual  official  opposition  to  hberty  and  anything  short  of 
senile  humbug.  In  the  Boer  War  no  one  of  any  independ- 
ence of  thought  was  selected. 

In  September,  to  refute  the  German  assertion  that  our 
soldiers  had  been  supplied  with  '  dum-dum  bullets,'  he  was 
asked  by  the  War  Office  to  report  on  the  rifle  and  revolver 
ammunition  issued  to  the  forces  ;  and  made  some  experi- 
ments, on  the  lines  of  his  previous  work  with  Dr.  Kramer. 
His  two  reports  bear  date  September  13  and  15,  I9I4.'^  There 
is  a  letter  to  him  from  the  War  Office,  September  15  : 

Lord  Kitchener  has  asked  me  to  thank  you  very  much 
indeed  for  your  memorandum  on  the  service  rifle  bullet 
in  reference  to  its  effects,  and  he  hopes  to  make  great  use  of 
it.  He  immediately  asked  me  about  the  revolver  bullet, 
and  I  told  him  that  you  had  very  kindly  arranged  to  send 
another  memorandum  on  that. 

In  October,  he  accepted  an  invitation  to  join  the  Union 
of   Democratic  Control ;    and  at  once   tried    to   persuade 

^  For  the  German  assertion,  see  the  Times,  September  10.  The  report 
of  the  War  Office  (Times,  November  lo)  proves  that  the  ammunition 
issued  to  our  forces  was  in  absolute  accord  with  the  requirements  of  the 
Hague  Convention.  It  says  also  that  German  troops,  '  both  in  Togoland 
and  in  France,  have  been  proved  to  have  used  bullets  with  a  soft  core 
and  hard,  thin  envelope  not  entirely  covering  the  core,  which  type  of 
bullet  is  expanding,  and  therefore  expressly  forbidden  by  the  Hague 
Convention.'  Such  bullets,  of  no  less  than  three  types,  were  found  on 
German  soldiers,  both  in  Togoland  and  in  France. 


LONDON.     WIMEREUX  289 

them  to  include  female  suffrage  in  their  programme.  On 
October  9,  in  Liverpool,  he  gave  the  Mitchell  Banks  Memorial 
Lecture.  He  spoke  of  Mitchell  Banks's  influence  on  the 
operative  treatment  of  cancer,  and  on  the  radical  cure  of 
hernia :  and  he  described  his  own  method  for  the  radical 
cure,  which  he  had  used  since  1890.  Finally,  he  spoke  of 
the  good  social  and  civic  work  which  Mitchell  Banks  had 
done  for  Liverpool ;   and  quoted  one  of  his  sayings  : 

We  must  be  something  more  than  mere  prescribers  of 
physic  and  healers  of  wounds.  In  my  youth  I  had  it  strongly 
recommended  to  me  to  stick  to  my  profession  and  leave 
everything  else  severely  alone.  The  life  of  a  doctor  was  to 
see  patients,  do  operations,  order  drugs,  and  collect  fees. 
I  thank  God  that  I  entirely  repudiated  this  idea  of  my 
profession. 

In  November,  he  took  part  in  a  controversy  over  the  best 
method  for  the  immediate  treatment  of  heavily  infected 
gimshot-wounds. 

By  December,  he  still  had  not  the  work  to  which  his 
record  in  science  and  practice  entitled  him.  To  be  one  of  a 
dozen  men  on  the  staff  of  a  Hospital  in  London  was  not 
good  enough  for  him.  It  is  worth  guessing,  what  Germany 
would  have  done  with  him,  if  it  had  possessed  him,  and  had 
not  imprisoned  him  for  his  politics.  Perhaps  it  would  have 
given  him  a  Hospital  of  a  thousand  beds  —  some  K.K. 
Anstalt  for  Wounds  of  the  Nervous  System — with  a 
host  of  doctors  and  nurses  working  under  him.  Mr.  Bond 
writes  : 

I  was  in  Australia  when  the  War  broke  out  ;  and  saw 
Horsley  soon  after  my  return  in  October  1914.  His  two 
sons  had  already  joined  the  combatant  ranks  of  the  New 
Army  :  and  when  I  returned  from  my  first  visit  to  France, 
in  December,  Horsley  expressed  to  me  in  forcible  and  moving 
language  his  own  great  desire  to  be  of  some  personal  use 
in  the  national  cause. 

Early  in  1915,  he  was  appointed  in  charge  of  the  Surgical 
Division  of  the  21st  General  Hospital,  for  service  in  France. 
Meanwhile,  he  had  promised  to  be  Surgeon  to  the  British 
Hospital  established  at  Wimereux  by  Sir  Henry  and  Lady 
Norman.     The  21st  General  Hospital  was  not  yet  organised  : 

T 


290  SIR  VICTOR  IIORSLEY 

he  was  therefore  allowed  to  keep  to  his  arrangements  for 
Wimereux. 

On  February  8,  he  opened  a  discussion,  at  the  Medical 
Society  of  London,  on  Gunshot  Wounds  of  the  Head.  He 
went  over  the  experiments  made  by  him  and  Dr.  Kramer  : 
and  he  took  point  by  point  the  signs  and  conditions  to  be 
observed  in  these  cases.  He  spoke  against  what  he  called 
the  wicked  tradition,  the  fatal  and  detestable  practice,  of 
'  leaving  head  cases  alone  '  ;  and  upheld  the  example  of  a 
case  in  which  Major  Sherran  had  saved  a  man's  life  by 
trephining  within  a  very  few  minutes  after  the  infliction 
of  the  wound.  There  is  one  touch  of  bitterness ;  and  no 
wonder :  '  I  have  not  been  permitted  to  see  any  cases  in 
the  present  War,  except  a  few  exceptional  cases  which 
happened  to  be  referred  to  me  unofficially.' 

On  March  8,  in  Leeds,  and  on  March  15,  in  Huddersfield, 
he  spoke  on  the  need  of  more  control  over  the  drink-trade. 
He  went  to  Wimereux  on  March  28. 

The  British  Hospital  was  in  the  Hotel  Bcllevue  ;  the  two 
first  floors  as  wards,  and  the  top  floor  for  the  Staff ;  their 
meals  at  a  near  little  restaurant ;  '  everything  quite  good 
and  simple  and  rough.'  His  letters  to  Lady  Horsley  begin 
with  his  hrst  impressions  of  Wimereux  : 

March  29.  This  place  would  reduce  you  to  tears  on 
coming  into  it,  and  twenty-four  hours  would  place  you  in 
Bedlam.  It  consists  of  half-built  French  houses  and  a  few 
hotels  planted  in  a  hollow  with  a  little  river,  muddy  because 
tidal,  about  15  yards  wide,  running  dowTi  the  middle.  The 
country  immediately  round  it  is  a  desert.  The  river  runs 
in  front  of  my  bedroom,  and  the  ducks  on  it  demand  their 
breakfast  punctuaUy  at  6  a.m.  with  no  uncertain  voice. 

The  '  family  party  '  was  a  happy  family  :  '  The  life  is  of 
course  interesting  and  very  pleasant  in  its  funny  way.  The 
Matron  and  sisters  are  all  excellent  and  know  their  work 
well.'  The  wards,  at  first,  were  half  empty  :  '  The  morning's 
work  has  taken  about  i^  hours,  but  the  experts  have  called 
on  me,  mirahilc  dictn,  and  so  that  takes  up  the  morning  as 
well.'  There  was  time  for  some  sight-seeing:  he  writes 
of  the  churches  at  Audinghen  and  Marquise,  the  '  wonder- 
ful  stateliness   in    a   small  church  —  all  Early  Enghsh   I 


LONDON.    WIMEREUX  291 

think  of  course  can  be  stately '  —  and  of  white  violets 
by  the  roadside,  and  of  the  Convalescent  Camp  :  '  From 
having  been  a  mud  misery  of  wet  tents  it  is  now  a  hutted 
estabhshment  very  thoroughly  installed  and  admirably 
administered,  thoroughly  and  economically  :  the  paths  all 
stone  causeways,  and,  between  the  huts,  flower-beds,  with 
national  symbols.'  On  Saturday,  dinner  with  the  mess 
of  the  14th  General  Hospital,  '  of  which  we  are  really  an 
annexe ' ;  on  Sunday — 

Sunday  was  rather  amusing.  Lady  Norman  had  insisted 
on  our  having  a  P.S.A.  as  soon  as  she  found  that  I  knew  all 
about  it  :  and  we  found  at  the  Convalescent  Camp  a  capital 
young  Canadian  lieut.  who  was  a  host  in  himself  and 
brought  down  a  congregation  for  us,  who  possessed  six 
experts  in  mouth-organs  and  a  piper  of  the  2nd  Gordons, 
Tennent  by  name,  who  was  in  Oswald's  company.  We 
began  the  show  with  the  Cock  of  the  North  on  the  pipes, 
and  then  Tipperary  by  the  mouth-organ  band.  Then  a 
hjnnn,  then  Norman,  who  I  insisted  on  being  in  the  Chair, 
read  at  my  request  the  55  Ps.,  which  he  did  with 
splendid  verve.  It  seems  he  is  a  great  reader.  Then  I 
gave  my  usual  war  address,  which  was  much  appreciated  : 
then  another  hymn  :  then  Won't  you  give  me  your  answer, 
Maggie  Mackenzie  ?  on  the  mouth-organs  :  and  another 
obligato.  Really  excellently  done  and  enormously  appre- 
ciated. Closed  of  course  with  God  Save  the  King.  Alto- 
gether a  vast  success.  The  Good  Templars  in  the  Army 
here  want  me  to  hold  forth.  I  will  write  to  Miss  Coomber 
and  get  her,  as  you  will  be  away,  to  send  me  out  my  slides. 
It  seems  they  have  a  lodge  here,  and  one  at  Boulogne.  (By 
the  way,  I  think  almost  all  the  mess  drank  wine  in  spite 
of  tlie  King.  I  quite  agree  as  to  the  Temperance  party 
keeping  low  awhile.  The  King's  example  is  I  can  sec  crush- 
ing, but  taking  time  to  work.)  In  the  evening  I  went  over 
to  the  Australian  Hospital,  where  they  have  every  three 
weeks  a  most  interesting  gathering  of  all  the  surgeons,  or 
two  from  each  hospital.  They  all  have  to  select  representa- 
tives, and  consequently  all  tlic  experience  is  well  collected. 
Then  a  beautiful  walk  home  over  the  ch0,  as  it  was  a  clear 
cold  evening. 

Monday.  Robinson  and  I  liavc  had  a  fine  time  in  pelting 
rain.  We  went  in  the  tram  to  Boulogne  :  settled  about  a 
poor  chap  I  have,  and  want  to  get  to  England  :  liopeless 
spinal-cord  paralysis :  a  fine  young  fellow  but  doomed  : 
and  I  am  anxious  to  get  him  home  to  see  his  people  before 
it  is  too  late.     The  haibour  is  a  mass  of  orderlies,  mud, 


292 


SIR  VICTOR  HORSLEY 


and  good-natured  hard-worked  officials.  Then  a  grand 
tour  to  the  old  tovvTi,  where  I  am  thankful  to  say  I  found 
Henry  viii's  cannon-ball  stuck  in  the  wall.  These  beggars 
here  would  not  beheve  in  its  existence.     The  children  of 


course  were  running  about  in  their  capes  in  all  sizes  and 
proportions.  In  consequence  of  the  said  rain,  I  found  two 
harrowing  sights  at  front  doors.  The  agony  of  the  fingers 
trying  to  reach  the  bell-push  was  only  equalled  by  the  con- 
vulsions of  the  legs.  Tragedy  No.  2  I  put  an  end  to  by 
ringing  the  bell  and  walking  away.     Long  before  we  got 


out  of  sight  we  saw  the  door  opened,  and  of  course  the 
unfortunate  one  went  in  hke  a  streak. 

Through  the  first  half  of  April,  the  work  was  slack  :  '  it 
is  the  unsatisfactory  business  of  amateurism.  These  private 
hospitals  are  not  wanted,  though  the  beds  are  '  :  and  his 
letters  to  his  wife  are  concerned  both  with  his  work  and 
with  hers — with  the  affairs  of  the  British  Women's  Temper- 
ance Association  and  the  Women's  Liberal  Association. 
And  one  letter  is  to  say  that  he  wants  twenty  cakes  of 
verbena  soap  from  Atkinson's  in  Bond  Street :   '  I  mislaid 


LONDON.    WIMEREUX  293 

mine  here  while  going  round,  and  two  sisters  thought  they 
were  being  distributed,  so  naturally  impounded  them  1 
Now  I  must  furnish  all  the  rest  !  and  have  one  for  myself  !  ' 
The  Hospital,  hke  private  hospitals  elsewhere,  had  to  ask 
for  patients  :   then  came  a  rush  of  work  : 

April  17.  Wc  have  had  such  a  day  and  night  business  of 
it  that  I  have  not  had  time  to  write.  Also,  there  was  a 
block  on  the  line,  and  consequently  the  septic  cases  arrived 
in  bad  state,  and  that  means  many  more  dressings  per  day. 
Now  we  have  got  things  straight,  and  I  am  thankful  to  say 
an  amputation  at  the  shoulder  I  had  to  do  for  spreading 
gangrene  is  going  to  recover.  He  is  such  a  splendid  chap  : 
a    Manchester    cotton-weaver.  .  .  .  Now    as    regards    your 

biz.     Of  course is  an  arrant  old  incapable  humbug.     She 

always  has  been  a  pro-alcoholist :  and  of  course  got  into 
very  serious  relations  with  the  American  quack  pra3dng 
woman  who  called  herself  a  doctor.  I  would  quietly  go 
for  her  at  the  meeting  bald-headed.  .  .  .  The  steady  deter- 
mination in  the  newspapers  of  the  alcoholists  to  disregard 
the  King  and  Lord  Kitchener  is  very  striking.     What  have 

and  ,  etc.  etc.,  done?     It  would  be  worth  while 

making  a  census  of  one's  friends.  Here  the  Normans  are 
the  only  ones  who  have  dehberately   followed  the   King. 

did    for    a    few    days,    and    then    relapsed  :     he    is 

extraordinary  in  liis  reactionary  ideas  :  but  90  per  cent, 
good  -  hearted.  Of  course  he  is  a  rabid  anti- suffragist. 
Fortunately  I  find  all  the  sisters  here  are  first-rate  people 
and  all  progressive :  so  when  we  are  thoroughly  sick  of  his 
and 's  '  arguments,'  we  can  concoct  plans  for  the  future. 

April  21.  >X'e  have  had  a  doing  of  it,  chiefly  owing  to 
the  number  of  cases  not  of  wounds  but  all  sorts  of  ailments, 
trivial  and  othcrv\'ise,  arriving  at  all  hours  of  day  and  night, 
especially  midnight.  That  part  is  very  badly  arranged,  as 
the  train  leaves  the  railhead  at  8  or  9,  and  takes  twelve 
hours  to  go  about  fifty  miles.  Every  case  has  to  be  looked 
at,  and  always  some  to  l)e  attended  to  at  once.  On  the  whole 
the  wounds  come  down  well  dressed  and  comfortable.  .  .  . 

made  me  very  angry  yesterday  by  coolly  saving  that 

we  (the  English)  were  on  the  whole  carrying  on  tiiis  war 
very  clicaply  !  He  meant  in  the  loss  of  hfe  I  I  told  liim 
that  if  he  were  in  the  firing  hnc  he  migiit  have  some  justifi- 
cation for  saying  such  a  thing.  April  25,  6  A.M.  y\s  I 
had  to  dress  a  case  at  4.  and  a  frcsli  convoy  of  wounded 
arrived  at  same  time,  I  am  up  and  writing  while  the  unfor- 
tunate victims  of  men's  government  arc  being  washed 
and  got  to  bed.  May  8.  We  are  having  a  steady  stream  of 
bad  cases  admitted  now  at  all  hours,  and  I  hoar  that  this 


294  SIR  VICTOR  HORSLEY 

is  likely  to  be  the  case  now.  As  a  matter  of  fact  all  this 
country  should  be  organised  as  Base-hospitals,  it  seems  to 
me,  at  least  as  far  as  Calais.  Etaples  in  my  opinion  is 
unnecessarily  far  off.  Unfortunately  we  are  beginning  to 
get  rather  more  sepsis  with  the  warmer  weather ;  and  the 
men's  chances  vary  directly,  as  I  maintained  last  August, 
with  the  promptitude  they  are  treated  with  after  the  moment 
of  wounding.  We  have  some  gassed  people,  but  on  the 
whole  not  bad  ones.  Four  head  cases  severe  all  doing 
well.  One  is  a  regular  Northumbrian  from  Alnwick,  who 
works  in  the  Park,  and  was  frightfully  bucked  because  the 
Duke  had  heard  he  was  gravely  wounded  and  wired  to 
know  how  he  was  getting  on.  He  was  shot  through  one 
frontal  lobe  and  partly  the  other,  so  he  is  a  '  good  case.' 

There  was  a  plan  for  his  wife  and  his  daughter  to  come 
over.  Le  Touquet  would  not  please  them — '  a  \'ile  hole  as 
you  may  suppose  of  the  worst  artificial  French  seaside 
place.  The  pine  -  trees  which  are  all  about  20  ft.  high 
are  interspersed  with  rustic  seats  ;  and  the  plage  a  hideous 
collection  of  houses.'     But  Etaples  promised  well : 

I  believe  it  would  be  quite  a  good  move  for  you  and  P. 
to  take  up  quarters  in  a  nice  old  house  there,  or  board  with 
some  decent  people.  I  saw  some  quite  good  houses,  one 
witli  a  beautiful  garden,  cherry-trees  full  blossom,  etc.  etc., 
and  Henri  iv  waDs. 

But  these  plans  came  to  nothing  :  for  in  May  the  21st 
General  Hospital  was  ordered  to  Egypt.  He  had  a  few 
days  in  London,  to  get  his  tropical  outfit  :  he  was  gazetted 
Major,  R.A.M.C.(T.)  :  and  on  May  20,  1915,  he  left  England. 
The  six  weeks  at  Wimereux  had  been  a  pleasant  time  :  but 
the  work  was  not  enough  for  him.  The  private  hospitals, 
even  the  best  of  them,  were  imperfect  instruments  :  he 
envied  the  discipline  of  the  Austrahan  Hospital :  '  They  are 
very  good  up  there,  and  have  got  their  place  on  strict 
military  footing.'  But  his  Wimereux  letters  are  delightful : 
for  they  recall  his  gaiety,  his  kindness,  and  his  enjoyment 
of  the  world's  kindness — its  fine  architecture,  and  its  white 
violets,  and  those  twenty  cakes  of  verbena  soap  from  Bond 
Street — and  his  last  sight  of  a  country  as  beautiful,  and 
almost  as  dear  to  us  now,  as  our  own. 


II 

Egypt 

The  Staff  and  Nursing  Staff  of  the  21st  General  Hospital 
left  Southampton,  on  H.M.S.  Delta,  on  May  20,  and  reached 
Alexandria  on  May  29.  He  began  well,  with  '  a  powerful 
Atlantic  swell  which  cut  off  half  the  population  of  our 
tables  and  established  for  me  a  great  reputation,  because  I 
went  round  and  dosed  the  sufferers  with  anti-nausique  and 
effected  great  and  marvellous  cures.  ...  I  am  glad  to 
say  the  21st  Hospital  is  shaping  very  well.  The  O.C,  Col. 
Robinson,  knows  his  job  and  does  it.  The  second  in  com- 
mand. Major  McDowall,  is  I  should  fancy  a  very  good  officer, 
and  one  who  not  only  knows  his  business  but  can  see  that 
we  do  ours  :  so  that  is  a  good  start.  I  come  next,  and 
therefore  all  the  bullying  must  start  from  my  level.  Our 
quarters  are  very  comfortable  :  a  few  have  cabins  to  our- 
selves, but  the  majority  are  in  ward  cots.  Unfortunately, 
as  the  ship  has  been  gutted  to  make  the  Hospital,  we  have 
to  feed  in  two  lots,  which  is  not  nice  for  those  who  must 
dine  at  6.  The  Captain  is  a  very  nice  little  chap,  Le  Mare 
by  name,  and  most  successful.  Altogether  it  is  a  very 
"  happy  "  ship.' 

May  22.  At  night  the  afterglow  was  magnificent.  Of 
course  you  won't  believe  I  saw  them,  but  the  colours  were 
Sky,  deep  blue,  green,  pale  yellow,  deep  red  ;  Sea,  dark 
indigo  :  shading  into  each  other  '  as  per  diagram.'  At  5 
I  woke  and  looked  out  just  in  time  to  sec  a  very  fine  pre- 
dawn effect  behind  a  really  large  hill  cape  with  a  dark  wreath 
of  cloud  round  it,  and  the  suspicion  of  dawn  as  a  hght  back- 
ground. 

May  24.  Wc  passed  Gibraltar  like  many  ships  do  '  in 
the  night,'  and  arc  now  going  diagonally  through  the  Strait 
some  120  m.  E.  of  Gib.  The  Spanish  coast  is  most 
effective   in   a   limited   way.     The   tops  of   the   mountains 


296  SIR  VICTOR  HORSLEY 

were  quite  '  floating,'  as  people  say,  on  the  mists.     The  sea 
is  calm  and  as  tedious  as  usual  with  nothing  to  be  seen. 

May  26.  The  Northern  shore  of  Algeria  developed  as  a 
wonderfully  forbidding  wall  rather  like  the  Lynton  coast  in 
general  design,  but  in  detail  simply  atrocious.  Blue  sand- 
stone and  limestone  cliffs  with  dry  watercourses  grooving 
them  and  curious  scrubby  woods  spread  over  the  ridge. 
Later,  the  coast  settled  down  into  the  conventional  sandy 
wastes  which  we  suppose  to  be  the  regular  thing  for  N. 
Africa.  We  have  now  turned  the  Tunis  comer  and  are 
running  past  a  volcanic  island  called  Pantellaria  covered  with 
the  usual  scrub  on  the  top,  and  most  of  the  rest  of  the  surface 
cultivated  in  little  fields,  and  each  small  holding  has  a  little 
house.  I  suppose  that  as  it  is  an  Italian  convict  station,  it 
is  a  kind  of  Botany  Bay. 

May  27,  We  are  grinding  away  through  a  pure  ultra- 
marine sea  almost  calm,  and  nothing  to  see  or  do.  Satan 
therefore  suggested  to  the  Colonel  that  he  and  the  two 
Majors  had  better  be  inoculated  against  typhoid  ;  so  we 
were  duly  done  and  my  arm  is  proportionately  disagreeable. 
However,  it  appears  that  the  regulations  say,  no  alcohol  of 
any  kind  is  to  be  taken  during  the  inoculation  period.  On 
enquiry  I  find  that  the  War  Office  worthies  learnt  by  experi- 
ence that  when  the  injection-area  began  to  hurt  owing  to 
the  local  congestion,  a  small  quantity  of  alcohol  (one  go 
of  whisky  for  example)  caused  not  only  much  more  pain 
and  throbbing  from  vascular  dilatation  but  also  produced 
more  headache  and  general  disturbance,  owing  to  the  fact 
that  sundry  toxins  being  also  present  in  the  blood,  the 
alcohol  increased  the  constitutional  discomfort  they  caused. 
It  is  really  a  lovely  demonstration  that  small  doses  of  alcohol 
produce  very  definite  ill-effects  on  the  body.  I  pointed 
this  out  to  the  drinkers  at  our  table  who  had  not  considered 
the  point. 

May  28.  Still  oozing  through  the  liquid  ultramarine  : 
and  nothing  else.  The  cats  here  on  board  are  amusing  and 
numerous.  The  progenitor  of  the  race  used  to  be  a  great 
ratter,  and  was  an  animal  of  great  discrimination,  because 
whenever  she  caught  a  rat  she  brought  it  to  the  Captain's 
cabin  to  present  it  to  him  :  and  if  he  was  not  in,  she  took 
it  to  the  1st  ofBcer,  who  of  course  was  pretty  sure  to  be 
in  his  bunk  if  the  Captain  was  out  and  about.  Nobody  else 
was  ever  noticed.  There  are  two  terra-cottas,  one  black 
(a  half-bred  Siamese),  one  iron-grey,  and  an  inexhaustible 
kitten  who  spends  most  of  his  time  on  his  hind  legs  and  makes 
us  all  the  200  rank  and  file  play  with  him.  .  .  .  The  climate 
is  just  beginning  to  stoke  up  and  feel  rather  like  New  York 
did.  I  can't  think  of  any  more,  you  will  be  glad  to  hear. 
Farewell.     Talking   at    Beaulieu   of   water-wagtails,    I    find 


EGYPT  297 

that  the  Arabic  for  him  is  Abu  faraikh,  which  means  '  Father 
of  Promenaders.'     Quite  agreeable,  is  it  not  ? 

He  was  in  Egypt  from  June  1915  to  March  1916.  In 
August,  Lady  Horsley  joined  him.  In  October,  he  visited 
Mudros  and  GalhpoU.  In  October,  also,  their  daughter 
joined  them.  In  November,  she  had  very  severe  dysentery, 
and  nearly  died  of  it.  At  the  end  of  the  year,  he  visited 
Mersa  Matruh.  In  February  1916,  he  got  a  few  days  with 
his  wife  and  his  daughter  at  Helwan  and  Luxor.  In 
February,  also,  he  received  the  honour  of  the  Order  of  the 
Bath.i  In  March,  he  went  to  India,  and  from  India  to 
Mesopotamia. 

Ahke  in  Egypt  and  in  Mesopotamia,  he  had  grave  reason 
to  find  fault  with  the  administration  of  the  medical  services. 
Nobody  doubts  that  they  were  ill-prepared  for  the  War  : 
nobody  doubts  that  he  had  much  to  do  with  their  im- 
provement. But  his  hatred  of  alcohol  tends  to  make  him 
embitter  the  case  :  he  writes  now  and  again  as  if  he  were 
fighting  for  dear  fives  against  men  so  dulled  by  whisky  that 
they  hardly  cared  to  do  the  right  thing. 

The  building  assigned  to  the  21st  General  Hospital  was 
the  Outer  Barracks,  close  to  the  Khedival  Palace,  Ras-el-Tin, 
Alexandria. 

His  letters  to  his  wife,  at  first,  are  in  great  part  concerned 
with  advice  to  her  not  to  come  out  till  the  hot  season  is  over : 

May  30.  .  .  .  No  real  preparations  made  for  us  at  all, 
so  we  shall  be  frantically  busy  licking  into  shape  the  rotten 
old  barracks  which  have  been  handed  over  to  us  to  convert 
into  a  hospital.  The  Israelites  in  Egypt  were  not  in  it 
re  making  tjricks.  We  arc  temporarily  billeted  in  a  frowsy 
Greek  hotel  until  we  have  made  comi)arativcly  clean  the 
floors  and  walls  (^f  our  new  (piarters.  Of  course  the  colours, 
sunset,  etc.  etc.,  are  lovely,  but  the  smells  and  flies  are  some- 
what   turgid.     June    i.  ...  So    much    for   climate.     Now 


*  This  was  the  last  of  his  many  honours  :  but  it  is  worth  noting  that 
Professor  Pctren,  of  Stockholm,  had  more  tlian  once  proposed  him  for 
one  of  the  Nobel  Prizes  :  and  that  he  had  accepted  an  invitation  from 
Vienna,  a  few  months  lK'f(ire  the  War,  to  ^'ive  the  Nothnajjol  Lecture. 
No  man  in  his  profession  had  more  (nciids  and  admirers,  up  to  the  time 
of  the  War,  in  Germany  and  Austria.  He  was  the  man  to  watch  oi>crating, 
to  be  proud  of  knowing,  to  ask  after — '  You  are  an  English  doctor ;  do 
you  know  Sir  Victor  Horsley  ?  ' 


298  SIR  VICTOR  HORSLEY 

for  Alexandria.  Really  not  worth  visiting  artistically.  As 
an  introduction  to  the  East,  and  a  halfway  house,  it  will 
pass  :  but  I  foresee  many  days  in  which  more  work  will  be 
a  relief.  For  you  and  P.,  life  would  be  very  slow  and  not 
pleasant,  unless  the  weather  was  tolerable,  which  of  course 
at  present  frankly  it  is  not.  Mind  you,  I  like  the  heat  and 
feel  extremely  well  with  it,  but  I  think  without  occupation 
it  would  be  unspeakable.  We  have  cockroaches  here  as 
big  as  mice  :  one  has  just  descended  my  chest  of  drawers. 
I  fear  this  little  invasion  would  not  please  you.  Mosquitoes 
are  just  getting  to  work.  {Xote. — The  said  cockroach  has 
just  gone  to  ground,  having  perceived  me  uneasily  from  an 
eyrie  on  one  of  the  brass  handles,  which  I  suppose  he  absurdly 
thought  suited  his  complexion  mimetically.)  So  much  for 
insects.  Now  for  history'.  I  cannot  now  explain  fully  the 
position  of  the  wounded  British  Soldier  out  here.  Thank 
goodness  the  boys  are  in  France.  .  .  .  You  cannot  in  adminis- 
tration get  people  of  one  age.  Naturally,  the  man  at  the 
top  is  a  good  deal  older,  and  '  What  was  good  enough  when 
he  was  a  young  man,'  etc.  etc.  That  is  the  only  way  I 
can  account  for  this  never-ending  repetition  of  conditions 
which  have  been  pilloried  from  the  time  of  Florence  Night- 
ingale onwards.  June  2.  I  went  this  morning  to  the  Indian 
Hospital  (San  Stefano)  and  found  them  in  great  feather, 
as  they  had  taken  my  advice  and  operated  on  a  head  case 
and  got  out  the  bone  and  pus  I  suggested  was  in  his  head. 
I  operated  for  them  on  a  like  case,  and  then  hurried  back 
to  our  shop  where  we  spent  a  busy  morning  setting  up  the 
theatre  and  A;-ray  departments.  .  ,  .  The  poor  old  Delta 
is  still  in  harbour  taking  off  wounded  in  an  outrageously 
slow  and  heartbreaking  way.  Among  them  to-day  was 
a  small  bugler  about  14  wounded  in  the  arm,  with 
apparently  a  tumour  on  his  shoulder.  This  on  examination 
proved  to  be  a  pet  monkey  concealed  under  his  coat  over 
his  dressings  !  I  am  glad  to  say  the  Maj.  R.A.M.C.  in  charge 
allowed  him  to  keep  his  monkey  on  the  ship  ;  so  they  will 
have  a  time  of  it,  I  expect,  going  home. 

June  7.  We  have  had  a  strenuous  three  days  bug  destroy- 
ing, masonry  ditto,  firing  with  paraffin  blowers  and  finally 
spraying  with  formalin  and  washing  with  crcsol  these  large 
barrack  rooms.  The  bug  section  I  led  with  three  most 
excellent  subs,  and  so  I  photographed  them  which  pleased 
them.  Then  we  had  to  clean  tlie  windows  and  doors,  so 
now  we  really  are  aseptic  at  the  present  moment.*    I  am 

*  Pte.  J.  K.  Matthews  writes,  May,  1917  :  '  I  was  in  Mesopotamia, 
and  just  at  the  time  he  arrived  there,  the  fellows  who  were  in  Hospital,  at 
any  rate  the  particular  one  in  which  I  was,  were  very  miich  bucked  up, 
and  talk  generally  was,  llungs  will  be  much  better  after  liorslcy  has  paid 


EGYPT  299 

sitting  in  the  verandah,  which  is  a  dusty  but  cool  brick 
loggia.  This  is  what  is  in  front.  The  broken  line  is  a  reef 
of  rocks  with  surf,  and  a  boat  is  making  for  a  gap.  The 
object  on  the  right  horizon  is  a  fort  we  busted  in  1882  : 
and  the  objects  on  the  sea-wall  are  two  normal  Egyptians 
in  their  niteys  conversing  affably.  The  surf  bar  with  the 
flat  shallow  bay  is  of  all  imaginable  colours  from  ultra- 
marine in  the  far  distance  to  light  transparent  green  in  the 
foreground.  .  ,  .  The  native  children  play  here  at  football 
in  the  broiling  sun  :  also  knucklebones  hke  the  Pompeians  : 
also  the  game  of  horses,  as  played  with  the  shirt  (only) 
as  reins.  Now  to  w^ork  again.  June  12.  I  had  my  second 
inoculation  on  Sunday.  Owing  to  there  being  no  pre- 
parations whatever  for  our  coming,  and  the  needs  for  the 
wounded  being  something  not  yet  to  be  described  and 
therefore  requiring  every  one  to  buck  up,  we  had  a  hot 
time,  and  on  Wednesday  I  wrenched  my  bad  arm,  so  it 
paid  me  out  with  a  feverish  attack  from  which  I  am  already 
recovered.  It  was  nothing  in  my  opinion  but  a  dose  of 
toxins,  and  sure  enough  has  disappeared.  .  .  .  Small  jokes 
have  enhvened  our  work.  We  were  hunting  for  operating 
overalls  and  aprons  :  and  while  I  was  laid  up,  one  of  my 
subs,  a  very  good  man,  said  he  had  found  them  and  was 
steriHsing  the  lot.  In  the  evening,  came  a  note  from  the 
Quarter  Master's  Office,  '  Would  he  very  kindly  return  the 
Cook's  aprons,  which  they  heard  were  being  sterilised  '  ! 

Jttne  14.  The  work  grows  exceedingly,  and  unfortu- 
nately the  difficulty  of  enthusing  our  own  people  to  do  the 
best  for  the  wounded  and  not  put  them  off  with  a  make- 
shift is  terrible.  Any  one  would  suppose  they  thought  it 
the  wounded 's  own  fault  they  got  injured  and  must  put 
up  with  a  few  wholly  avoidable  inconveniences,  many  of 
which  can  cause  death  itself.  I  really  could  not  have 
imagined  such  wooden  cerebration.  The  equipment  of 
this  hospital,  supposed  to  be  most  modem,  falls  short  of 
absolutely  essential  things  in  some  cases,  and  I  am  trying 
to  get  them  locally,  but  it  requires  incessant  appHcation 
to  the  powers,  who  not  being  conversant  with  modem  surgery 
cannot  of  course  recognise  the  terribly  urgent  need  of  various 
essentials.  The  usual  formula  is,  Can't  you  ask  Sister  to 
do   it  ?    Sister   being   already   done   to   death.      Meantime 

us  a  visit :  and  such  a  bright  picture  was  painted  that,  when  his  death 
was  announced — well,  to  say  the  Ica-st,  it  was  a  terrible  shock.  Kvcn- 
tually,  1  arrived  at  a  flospital  in  Alexandria  :  and  it  happened  to  Iw  ono 
which,  when  it  was  taken  over,  needed  a  lot  of  cleaning  out  :  and  I  met 
there  <i  man  who  told  rae  Sir  Victor  w;is  with  their  detachment  when  they 
took  over  this  place,  and  spoke  in  glowing  terms  of  him  taking  his  sharo 
with  the  iTifn  in  all  kinds  of  dirty  work  which  was  needed  to  make  things 
suitable  fur  Hospital  work.' 


300  SIR  VICTOR  HORSLEY 

liberal  expenditure  on  the  drink  trade,  and  the  Sister's  salary 
cut  down. 

June  17.  The  chaos  here  continues  in  full  swing,  out  of 
which  we  are  slowly  evolving  a  hospital.  We  are  told  we 
are  to  receive  400  sick  and  wounded  to-day.  We  have 
nurses  for  150 !  To  supplement,  I  understand  other  places 
which  arc  understaffed  and  overworked  are  to  be  still 
further  denuded  to  supply  our  wants.  ...  I  see  they  have 
actually  run  a  Derby  in  England.  Certainly  the  hold  drink 
and  gambling  has  on  our  people  to  the  exclusion  of  every- 
thing else  is  inconceivable  except  to  those  who  have 
reahsed  it  before.  The  mess  still  goes  on  in  its  stupid  and 
disloyal  alcoholic  way. 

Jtme  20.  I  had  to  come  into  Alexandria  to  hunt  up  some 
x-ray  help,  since  the  creators  of  chaos  have  poured  160 
wounded  upon  us  while  we  are  getting  in,  and  while  our 
.r-ray  apparatus  cannot  be  fixed  up,  as  they  know,  till 
Thursday.  This  is  the  history  of  all  the  hospitals  here  :  and 
some  have  none  at  all.  The  public-house  loafer  at  home 
is  far  better  treated  by  the  nation  medically  than  the  soldier 
who  is  sacrificing  his  life.  Of  course  the  usual  lie  will  be 
uttered,  '  Oh,  but  this  is  War.'  The  net  result  is  that  the 
shirker  and  drinker  benefit  enormously  and  the  unfortunate 
wounded  are  practically  told  to  shut  up.  The  work  as  you 
can  understand  is  depressing  beyond  words,  and  the  more 
so  as  every  effort  to  get  better  drugs  and  conditions  is 
criticised  and  thwarted  as  if  something  unreasonable  was 
being  asked,  instead  of  the  bare  essentials  of  medical  treat- 
ment. Egypt  produces  nothing  but  raw  cotton  and  food. 
Consequently  when  the  home  authorities  refuse  to  send  out 
x-vdcy  plates  ordered  as  long  ago  as  last  April,  it  is  obvious 
that  the  drink  trade  has  got  well  hold  of  our  nation,  for 
they  know  that  we  cannot  by  any  manner  of  means  get  hold 
of  these  prime  necessities  of  mihtary  surgery.  One  authority 
I  heard  of  dared  to  say  of  A;-rays  that  they  were  '  so  mis- 
leading.' Of  course  such  an  infemahty  he  would  not  venture 
to  say  in  a  meeting  at  home.  I  am  not,  therefore,  in  any 
condition  to  write  you  amusing  or  interesting  letters  :  all 
my  energies  are  devoted  to  trying  to  get  for  our  unfortunate 
men  the  merest  elements  of  mediccd  care. 

On  June  24,  he  writes  to  a  friend  in  England,  '  In  a  few 
days  I  shall  be  appointed  Consultant  (I  am  practically 
acting  as  such  now)  to  the  hospitals  :  so  my  sphere  of  work 
will  be  altered,  and  I  shall  be  rushing  about  all  over  Alex- 
andria and  its  suburbs  instead  of  superintending  the  one 
department  in  this  hospital.'     On  July  14,  he  was  appointed 


EGYPT  301 

Consultant  to  the  Mediterranean  Expeditionary  Force,  with 
the  rank  of  full  Colonel,  A.M.S.,  with  the  duty  of  visit- 
ing hospitals,  hospital  ships,  and  officers,  in  the  interests  of 
the  sick  and  wounded.  He  is  outspoken  :  he  writes,  for 
example,  in  one  of  his  reports,  '  I  have  just  been  on  board 

the  ,  a  so-called  hospital  ship  (though  her  latrines  are 

defective,  her  operating  theatre  wretched,  and  she  has  no 
x-ray  apparatus  at  all)  because  a  case  of  gunshot  wound  of 
the  brain  was  admitted  from  her  in  a  hopeless  state  into 
the  2ist  General  Hospital.' 

He  and  Lady  Horsley  and  their  daughter  had  rooms  in 
Mme.  Caillard's  house,  Villa  Yasmin,  Glymenopoulo,  near 
Ramleh.  Colonel  Tubby,  Consultant  M.E.F.,  who  also  was 
at  Villa  Yasmin,  remembers  that  Horsley,  even  in  the  heat 
of  the  summer  and  autumn,  used  to  work  through  the  hot 
evenings,  writing  letters  and  notes  of  his  cases.  A  car, 
after  some  delay,  was  allotted  to  him  :  it  was  a  4-cylindered 
Bayard,  eleven  years  old  and  worn,  but  it  behaved  far 
beyond  expectations  :  it  was  named  The  Emden.  Mr. 
Edward  May,  his  chauffeur  during  the  last  two  months  in 
Egypt,  remembers  of  him  that  '  When  driving  along  at  any 
time  of  the  day,  should  a  nurse,  soldier,  or  one  of  my  own 
friends  be  going  our  way,  he  would  always  stop  the  car 
and  give  them  a  lift.  At  times  he  would  go  out  to  Aboukir 
in  the  desert,  by  some  old  ruins — fossil-hunting  as  I  used 
to  term  it.^  There  were  always  three  or  four  friends  with 
him  on  these  trips,  so  we  used  to  have  tea  in  the  desert  before 
we  returned  home  :  my  duty  was  to  get  the  billy  boiling 
whilst  he  prepared  the  tea  :  on  no  ;iccount  would  he  let 
me  sit  away  from  the  party  :  and  on  one  or  two  occasions 
we  had  our  photos  taken  .  .  .  Upon  returning  from  the 
hospitals  one  day,  he  presented  me  with  a  book  of  which 
he  was  part  author,  "  Alcohol  and  the  Human  Body."  He 
put  inside' ,  To  Edward  May,  with  one  of  the  authors'  best 
wishes  for  a  speedy  return  to  civilisation  and  common- 
sense.' 

*  Horsley  never  look  out  the  car  except  when  >t  had  to  go  on  Hospital 
work  ;  he  was  very  careful  to  keep  to  tins  rule.  The  halt  at  Aboukir 
woald  be  od  tho  way  to  or  from  a  Hospital. 


302  SIR  VICTOR  HORSLEY 

Of  Horsley  at  Gallipoli,  Major  Aspinall,  ist  Field  Ambu- 
lance, ist  Division  Australian  Army,  writes  : 

I  met  Sir  Victor  Horsley  at  Anzac  on  14th  October  1915. 
He  had  been  visiting  the  medical  units  at  Suvla  Bay,  and 
came  across  to  Anzac.  Colonel  (now  Sir  NeviUe)  Howse,  V.C., 
deputed  me  to  take  Jiim  round  to  see  the  conditions  under 
which  Field  Ambulances  were  working  in  '  dug-outs.'  On 
walking  round  I  was  much  struck  by  the  ease  with  which 
he  walked  up  steep  paths  without  showing  the  least  sign  of 
exhaustion  :  he  told  me  that  he  was  in  very  good  condition. 
At  that  time,  in  response  to  our  appeal  for  more  medical 
men  from  the  base,  some  fairly  old  men  had  volunteered 
and  been  sent  up.  Speaking  to  Sir  Victor  about  the  deple- 
tion of  our  medical  officers  from  sickness  and  wounds,  I 
made  the  remark  that  in  my  opinion  it  was  wrong  for  men 
of  some  fifty  years  or  thereabouts  to  be  exposed  to  the 
danger  and  discomfort  of  work  at  the  front  under  the  trying 
conditions  we  were  experiencing  at  Gallipoli  just  then,  and 
said  that  it  was  a  young  man's  job.  To  my  surprise  he 
said,  '  I  do  not  agree  with  you  :  the  loss  of  a  young  life  is 
of  much  more  consequence.  For  example,  what  does  it 
matter  if  I  am  killed  ?     I  have  had  my  day.' 

Talking  to  him  as  we  were  walking  along,  I  was  much 
impressed  with  his  courtesy,  and  the  kind  way  in  which  he 
listened  to  my  account  of  head-wounds  I  had  seen,  and 
the  trouble  he  took  to  answer  my  questions.  One  of  our 
officers.  Major  Dunlop,  a  young  man  like  myself,  had  been 
seen  by  him  :  almost  every  one  who  met  him  at  Anzac 
asked  him  if  he  had  seen  Dunlop,  and  to  each  he  repHed  so 
kindly  and  thoroughly.  On  October  15  he  addressed  a 
gathering  of  all  the  medical  men  who  could  be  present,  at 
the  Stationary  Hospital  recently  erected  in  tents  near  the 
beach,  and  gave  a  most  interesting  address  on  the  best 
methods  of  deahng  with  wounds  under  the  unusual  condi- 
tions met  with  at  Anzac,  where  there  was  no  place  free 
from  the  risk  of  sheU  fire.  This  gathering  really  suggested 
the  formation  of  the  Anzac  Medical  Society. 

He  was  away  on  this  visit  from  October  i  to  October  23. 
He  reports  of  it  : 

I  walked  over  the  ground  at  Suvla  Bay,  Anzac,  and  Cape 
Helles,  and  visited  almost  all  the  Field  Ambulances  and 
Casualty  Clearing  Stations,  as  well  as  many  of  the  regi- 
mental dressing  stations  and  advanced  dressing  stations  in  the 
supi  orting  trenches  and  in  the  firing  Une.  At  each  of  the 
clearing  stations  and  aml:)ulances,  the  officers  commanding 
kindly  collected  their  officers  as  far  as  possible,  when   I 


EGYPT  303 

had  the  opportunity  of  addressing  them  and  consulting 
with  them  on  their  experiences  and  difficulties.  In  this 
way  much  time  was  economised,  e.g.  at  Anzac  some  sixty 
officers  attended. 

He  recommends  that  a  short  pamphlet  should  be  printed 
and  circulated,  with  notes  on  the  use  of  the  Hey  Groves 
splint,  and  on  other  details  of  treatment.  And  he  calls 
attention  to  (i)  the  absence  of  roofing  materials  for  the 
dug-outs,  (2)  the  shortage  of  warm  clothing  and  covering, 
(3)  the  absence  of  digestible  fatty  food.  '  On  all  these 
points,  special  action  should  be  taken  at  once,  not  only  on 
behalf  of  the  troops  on  the  Peninsula,  but  also  those  who 
are  under  canvas  at  Mudros.' 

On  November  30,  he  writes  to  Dr.  Mary  Sturge  : 

A  hurried  Hne  to  say  that  we  are  passing  through  a  terrible 
time  here,  as  Pamela  has  a  very  severe  attack  of  dysentery. 
.  .  .  To-day  she  is  much  better  thank  goodness  and  I  am 
assured  tliat  she  has  good  prospects.  Fortunately  we  got 
her  into  the  5th  Indian  Hospital  here,  where  McCarrison  has 
simply  devotedly  waited  on  her  actually  hourly.  Every  one 
is  very  kind,  and  the  Matron  of  17th  Gen.  Hospital  has 
sent  me  splendid  sisters  to  nurse  her.  Eldred  has  stood 
the  strain  splendidly  :  but  really  what  she  has  had  to  go 
through,  the  last  18  months,  is  intolerable  to  think  of. 
Looking  back  over  these  8  days,  one  can  see  that  Pamela 
has  made  a  fine  fight  of  it,  and  as  symptoms  are  bettering 
and  not  worsening  I  suppose  we  are  entitled  to  optimism. 
I  am  sorry  to  give  you  such  a  sketchy  account.  I  know 
you  must  want  to  ask  a  hundred  questions,  but  it  cannot 
be.  I  must  write  when  the  anxiety  is  less  heavily  on  me 
than  it  is  now  :  and  I  have  an  article  for  Pitman's  on  Parent- 
hood and  Alcohol  I  must  turn  to.  By  the  way,  I  was 
scandalised,  on  opening  our  book,  to  find  a  vulgar  design 
by  Walter  Crane  of  a  young  man  and  woman  drinking  wine 
and  Cupid  underneath.  This  on  a  bookmarker  by  the 
Scottish  Widows  Co.  I  wrote  to  tiiem  and  to  Macmillan. 
The  former  iiave  answered  as  enclosed.  Of  course  to  Mac- 
millans  I  protested  against  such  a  thing  being  stuck  in  our 
book,  and  to  both  I  protested  against  its  issue  just  now  when 
the  country  was  staggering  with  drink  when  it  ought  to  be 
marching  against  the  enemy. 

In  Dect-mbcr,  he  went  to  Mei-sa  Matruh,  to  inspect  and 
help  to  organise  the  medical  arrangements  on  the  Western 


304  SIR  VICTOR  IIORSLEY 

front  of  our  forces  in  Egypt.  He  writes  in  igi6,  from 
Alexandria,  to  Miss  Alys  Clarke,  one  of  his  patients  in 
England  ;  a  long  illustrated  letter,  to  amuse  a  young  Irish 
girl: 

I  was  ordered  here  from  France  last  May,  and  may  get 
pushed  on  somewhere  else.  In  September,  I  went  up  to  the 
Front  on  the  Gallipoli  peninsula  and  to  Lemnos,  i.e.  Mudros. 
When  I  got  back  from  there,  they  sent  me  just  after  Xmas  to 
the  western  front,  about  170  miles  from  here,  where  we  are 
fighting  the  Turks  and  Arabs  who  have  been  paid  by  the 
Germans  to  make  a  dust  in  Egypt  on  the  side  opposite  to 
the  Canal.  But  they  are  wondrously  stupid,  because  their 
notion  of  attacking  is  so  spasmodic,  it  is  quite  obviously 
nothing  but  a  draw-off.  The  place  I  went  to,  I  dare  say, 
you  won't  find  in  a  map,  but  it  must  have  been  '  some  place,' 
as  the  Americans  say,  in  the  time  of  the  Romans.  It  is 
called  Mersa  Matruh  :  Mersa  is  Arab  for  harbour.  The 
harbour  is  a  landlocked  bay  of  deep  blue  water  and  exquisite 
white  sand  on  a  rocky  base,  so  that  steamers  can  lie  up 
against  the  sand  as  it  were.  There  are  three  such  lagoons  ; 
one  is  now  cut  off  completely,  and  called  the  Salt  Lake. 
The  third  on  the  W.  side  was  the  chief  Roman  harbour, 
and  still  has  Roman  quays,  etc.,  which  of  course  Antony 
and  Cleopatra  are  said  to  have  used  when  he  had  to  make 
tracks  after  the  battle  of  Actium.  By  the  way,  Cleopatra's 
portraits  on  her  coins  here  make  her  as  you  might  imagine 
a  very  unpleasant  party.  Of  course  as  a  matter  of  fact 
all  the  Egyptian  queens  of  that  period  were  not  the  sort 
of  people  you  would  have  called  on  or  asked  in  to  tea.  Just 
below  the  hills  on  which  our  pickets  were  set  there  were 
very  interesting  remains  :  one,  a  Roman  villa,  with  a  great 
deal  standing.  ...  I  am  so  glad  you  are  well,  and  the  scar 
improving.  When  the  war  is  over  we  must  meet  again. 
I  hope  they  give  you  plenty  to  eat  and  plenty  of  time  to 
play  at  the  College  !  When  we  meet  again  I  am  sure  you 
will  agree  that  Carson  is  no  good  ! 

Another  letter,  February  2,  1916,  is  to  an  English  friend 
in  America.  It  was  written  in  one  of  his  moods  of  extra- 
vagant thought : 

...  If  the  Enghsh  people  choose  to  go  on  without  universal 
suffrage  for  men  and  women,  then,  as  Lecky  points  out,  they 
will  have  to  have  wars,  and  as  they  get  killed  and  the  kings 
and  emperors  don't,  it  does  seem  rather  stupid  of  them. 

My  eldest  son  Siward,  who  was  wounded  at  Neuve  Chapelle, 
has  been  invalided  and  is  at  present  testing  steels  in  Arm- 


EGYPT  305 

strong's  gun  works.  The  second,  Oswald,  who  was  shot  in 
the  left  shoulder  in  1914,  was  hit  in  the  right  shoulder  last 
August,  but  luckily  without  involving  the  joint.  He  was  in 
charge  of  the  bombers,  and  rather  distinguished  himself,  so  has 
been  mentioned  in  despatches  ;  and  is  now  back  at  Aberdeen 
getting  a  new  draft  to  go  out  again.  My  wife  joined  me  out 
here  in  August  :  and  Pamela  in  October  while  I  was  up 
at  the  front  in  GallipoH.  They  worked  in  the  stores  of  a 
neighbouring  hospital  :  and  Pamela  was  struck  down  with 
malignant  dysentery.  Fortunately  she  had  the  devoted 
care  of  an  I. M.S.  colleague  of  mine.  Major  McCarrison,  who 
pulled  her  through  splendidly  :  and  after  six  weeks  I  got 
her  and  her  mother  off  to  Helwan  near  Cairo  where  they 
are  rusticating  and  recuperating  on  the  desert  edge.  Now 
you  know  all  about  us. 

As  to  what  we  are  doing,  I  can  only  say  that  my  whole 
Hfe  is  spent  trying  to  get  order  out  of  chaos,  trying  to  make 
the  aged  and  incompetent  realise  that  the  British  Soldier  is 
a  human  being.  ...  It  is  very  difficult  to  explain  the  sense 
of  weariness  produced  by  the  dull  apathetic  indifference  of 
the  person  above  you  in  command.  And  what  is  also  fatigu- 
ing is  the  realisation  that  owing  to  the  censorship  and  oli- 
garchical government  the  people  at  home  are  kept  in  a 
fool's  paradise.  I  daresay  it  's  not  a  fool's  paradise,  but 
they  have  no  real  conception  of  what  is  going  on.  What 
too  is  irritating  is  that,  as  of  course  we  shall  win  ultimately, 
it  is  certain  that  the  lives  sacrificed  will  be  wholly  forgotten 
in  a  year  or  two,  except  by  the  poor  relatives  of  those  thou- 
sands who  have  died  for  absolutely  nothing,  and  the  hundred 
and  fifty  thousand  who  have  been  crippled. 

He  writes  on  another  subject  to  a  friend  in  England, 
January  14,  1916  : 

I  quite  agree  with  you  as  to  our  future  bearing  towards 
our  German  friends.  It  is  impossible  for  our  or  the  next 
generation  to  trust  them  again ;  but  I  do  not  see  that  any 
action  could  be  taken  on  such  distrust,  aj)art  from  non- 
employment  and  non-assistance  on  any  but  humanitarian 
problems.  These  they  are  not  likely  to  trouble  us  with  : 
but  to  take  a  case  in  point,  any  medical  question  we  ought 
to  help  them  to  solve  just  as  our  own  people.  Personally  I 
shall  never  invite  any  of  my  former  German  friends  to  my 
house,  etc.  It  is  not  a  question  of  thereby  depressing  the 
activities  of  the  decent  peo{)le.  Tliat  would  have  some  force 
with  me  as  an  argument,  if  it  were  shown  that  the  decent 
minority  are  not  completely  Ilohenzollerned.  As  a  matter 
of  fact  it  is  clear  that  they  arc.  .  .  .  The  naturally  servile 
brain  of  the  German  is  completely  cowed.     Unfortunately 

U 


3o6  SIR  VICTOR  HORSLEY 

our  stupidity  and  drunken  misdirection  of  our  militaxit  efforts 
simply  encourages  the  German  slave  in  his  belief  that  his 
slavery  is  something  miles  better  than  our  freedom. 

During  January-March,  1916,  Lady  Horsley  and  Miss 
Horsley  were  first  at  Hehvan,  then  at  Luxor.  His  letters 
give  them  not  only  health-advice,  but  the  news  of  each 
day's  doings,  his  movements,  the  comedy  and  gossip  of 
Alexandria,  and  what  he  thinks  of  So-and-so,  and  httle 
fugitive  jests  and  scores  ;  anything  to  hghten  the  depres- 
sion of  convalescence  in  exile.  He  has  £140  left  of  a  gift 
from  Mr.  Cadbury  to  buy  comforts  for  soldiers  ;  and  he 
makes  a  fine  list  of  quantities  and  prices  of  them.  He 
writes  also  of  pohtics  in  England  ;  of  the  evasiveness  of  a 
well-known  member  of  the  Union  of  Democratic  Control ; 
of  a  visit  with  Signor  Breccia  to  some  excavations  at 
Aboukir  ;  of  a  surgical  discussion  (March  2,  1916),  at  the 
17th  Hospital,  on  head-injuries  :  ^  and  of  some  of  his  patients 
— they  ranged  from  a  Pasha's  daughter  at  Cairo  to  Mme. 
Caillard's  Persian  cat.  His  longing  for  the  happiness  of 
his  wife  and  daughter  is  incessant :  '  I  try  to  stir  up  every 
nice  person,  e.g.  Col.  Grey,  to  go  to  Luxor  if  possible  at 
once.  They  ought  some  of  them  to  roll  up  and  make 
things  pleasant  for  you  both.'  For  himself,  the  trouble  is 
that  his  work  is  falling  off : 

February  1,  1916.  I  hope  the  Museum  business  is  proving 
as  pleasant  as  your  letter  sounded  ;  also  that  stray  guests 
and  friends  continue  to  crop  up  and  amuse  P.  Here  things 
are  in  a  very  funny  state.  No  one  seems  to  have  anything 
to  do,  and  yet  they  drift  along  contentedly  just  like  May- 
flies on  a  stream.  February  5.  It  is  a  godsend,  these  people 
turning  up  to  keep  the  ball  rolling :  long  may  they  flourish. 
I  am  struggling  hard  to  clear  off  the  things  to  be  written, 
but  somehow  carmot  get  anything  done,  though  the  work 
in  the  hospitals  has  sunk  to  absolute  zero.     AU  sorts  of 

»  '  We  had  a  very  successful  meeting  yesterday  at  No.  17  on  the  Head- 
injuries.  Quite  130  turned  up.  I  introduced  the  subject,  and  Boyd  and 
Whitaker  read  excellent  papers.  Net  result  of  discussion,  warm  approval 
of  my  method.  But,  such  is  life,  I  went  to  19  this  evenmg  and  found 
a  really  serious  case  whose  external  wounds  had  scabbed,  with  no  dress- 
ings on  his  head  !  It  really  is  enough  to  make  one  physically  cry.  I 
don't  know  what  can  be  done  to  alarm  our  people.  They  seem  to  have 
no  fear  of  microbes.' 


EGYPT  307 

changes  are  developing  rapidly.  February  6.  Obviously  in 
another  fortnight,  unless  the  Mersa  Matruli  people  buck 
up,  there  will  be  nothing  doing  at  all.  Fortunately  Sandwith 
is  here,  and  responsible  for  all  the  medical  work.  No  fight- 
ing, no  surgical  work  :  so  there  you  are. 

The  week  or  ten  days  of  holiday  with  his  wife  and  his 
daughter,  at  Luxor,  were  a  golden  time,  every  hour  of  them. 
He  had  borne  the  fearful  strain  of  his  daughter's  illness  : 
he  had  done  enduring  work  in  Egypt  :  he  was  beginning 
to  feel,  with  all  sorts  of  changes  developing  rapidly,  that 
even  greater  work  was  coming  to  him.  He  had  got  away, 
at  last,  from  all  that  he  disliked  in  Alexandria  ;  he  gave 
himself  joyfully  to  sight-seeing,  admiring,  photographing — 
one  or  more  photographs  were  obtained  by  swarming  up 
a  telegraph-pole — never  w^as  he  happier  than  in  these  few 
days. 

Back  in  Alexandria,  he  writes  to  Lady  Horsley  at 
Luxor : 

February  28.  I  hope  you  people  are  using  your  mosquito- 
net  curtains.  I  find  the  sand-fly  occurs  at  Luxor,  as  well  as 
mosquitoes :  and  its  fever,  which  is,  I  take  it,  the  same 
thing  as  dengue,  is  very  annoying  though  not  dangerous. 
Also  I  hope  Walshe  is  really  better.  Tell  him  that  the  spine 
man  at  17th  Gen.  Hosp.  does  not  require  operation :  he  is 
enormously  better.  Whitaker  is  going  home.  It  is  said 
that  nothing  is  in  the  air  here  or  likely  to  be :  but  of  course 
every  one  is  as  ignorant  as  his  neighbour. 

On  March  5,  he  writes  of  a  picnic  at  Aboukir — '  The 
desert  flowers  are  wonderful  :  sheets  of  blue,  etc.,  all  small 
but  extraordinarily  spread  ' — and  of  his  work  :  '  To-day 
I  have  had  to  operate  at  the  Indian,  and  Ras  el  Tin ;  and 
got  through  the  mail :  but  get  a  moment  to  write  up  what 
we  have  done,  I  cannot.'  Then  he  says,  '  Finding  there  was 
much  work  at  Bombay,  I  raised  the  point  of  my  going  there 
to  Babtic.  He  wrote  saying  it  was  not  his  area  (really 
Indian  Govt.)  and  wanted  to  know  whether  I  wished  to 
go  home.  It  is  a  rotten  position,  asking  people  what  they 
want  when  you  don't  tell  them  a  word  as  to  what  is  likely 
to  happen.  I  am  answering  liini  tli.it  I  am  in  their  hands, 
all  I  want  is  work.   ...   I  know  all    the    ropes    here  :    it 


308  SIR  VICTOR  HORSLEY 

would  be  stupid  of  them  to  throw  that  away.     However, 
we  shall  see.' 

On  March  9,  he  writes  to  one  of  his  patients  in  England  : 

Poisonous  though  this  country  is  in  microbic  maladies  and 
all  the  vices  that  man  is  possibly  capable  of,  it  possesses  a 
charming  climate,  and  the  antiquities  are  worth  all  they 
say  about  them.  Moreover  tlie  Gippy  himself  has  his  points, 
and  considering  the  outrageously  parasitic  manner  in  which 
all  the  High  Contracting  Xtian  Powers  sit  and  feed  on 
him  and  profit  by  his  extraordinary  industry  (when  super- 
vised !)  he  is  to  be  respected  as  well  as  pitied.  Not  having 
much  of  a  kick  in  him,  he  naturally  lies  down  and  leaves  all 
the  fighting  to  his  Bedawi  friends  who  rattle  about  the  desert 
on  the  fringe  of  the  cultivated  areas.  ...  I  don't  know  what 
is  going  to  be  done  with  us,  of  course.  This  force  is  being 
scattered,  I  expect  to  France  in  the  main,  but  I  may  be 
sent  to  Bombay  or  possibly  Basrah.  The  only  wounded 
practically  are  in  that  area  now. 

He  writes,  the  same  day,  to  a  friend  in  England  : 

In  this  unfortunate  country,  since  all  business  is  in  the 
hands  of  parasitic  foreigners,  no  one  cares  about  social 
questions  really  ;  and  though  the  editor  of  the  chief  news- 
paper here  is  very  bright,  he  cannot  create  an  atmosphere 
which  does  not  exist.  It  is  very  serious,  because  it  blocks 
sanitary  progress  as  well  as  other  branches  of  intellectual 
work.  .  .  .  Eldred  and  Pamela  come  back  to-night,  and 
will  return  to  England  in  April.  I  have  to  wait  for  orders 
from  the  W.O.  before  moving,  as  they  may  want  one  for  the 
Mesopotamia  wounded.  If  not,  one  would  hope  for  the 
clearing  up  in  France  to  be  the  last  stage,  and  get  over  there 
from  here. 

On  March  15,  he  left  Port  Said  for  India.     He  writes,  on 
his  way  out,  to  one  of  his  sons  : 

I  heard  there  were  some  considerable  difBculties  in  the 
Persian  Campaign,  so  volunteered  :  and  after  a  few  days' 
work  in  Bombay  expect  to  sail  for  the  Tigris,  so  as  to  get  as 
near  as  I  can  to  the  front.  There  is  no  doubt  that  one  can 
be  of  most  use  the  nearer  to  the  firing  hue,  as  the  worst  cases 
are  the  most  difficult.  Of  course  tlie  poor  old  Turks  may 
shake  off  the  German  yoke,  but  I  doubt  it. 

On  the  whole,  he  had  enjoyed  his  time  in  Egypt :  he  had 


EGYPT  309 

seen  something  of  its  wonders  and  its  antiquities, ^  had 
gained  many  friends,  had  made  his  work  tell  :  and  he  now 
was  looking  forward  to  the  '  one  fight  more,  the  best 
and  the  last.'  Sir  Henry  Maudsley,  Professor  of  Medicine 
in  the  University  of  Melbourne,  and  on  active  medical 
service  in  the  Australian  Army — he  and  Horsley  had  been 
together  at  University  College  Hospital  in  1881 — remembers 
Horsley's  delight,  the  evening  before  he  left  Alexandria, 
at  the  thought  of  going  where  he  would  '  have  a  free  hand.' 
Four  letters,  from  other  men  who  knew  him,  must  have 
a  place  here. 

From  Capt.  Arderne-Wilson 

I  often  had  the  pleasure  of  meeting  him  at  tlie  Bombay 
Presidency  General  Hospital,  San  Stefano,  where  he  frequently 
came  as  consulting  surgeon  in  the  cases  of  injuries  involving 
the  nerv'ous  system.  One  morning  he  was  to  remove  a 
bullet  from  the  neural  canal  in  the  lower  dorsal  region.  He 
directed  that  the  operation  would  be  performed  at  9  a.m. 
He  arrived  at  8.55,  prepared  himself  in  the  ante-room,  and 
walked  into  the  operating  -  room  ;  the  patient  was  only 
just  then  being  brought  in  ;  he  expressed  surprise  at  this. 
He  was  told  that  the  patient  was  brought  up  immediately 
he  arrived.  With  a  smile  he  kindly  and  gently  but  firmly 
said,  '  Please  understand  for  the  future  that  when  I  say 
the  operation  is  to  be  at  9  a.m..  I  make  my  incision  at  that 
time.' 

From  Lt.-Col.  Luxford,  C.M.G.,  chaplain  N.Z.E.F. 

Perhaps  I  am  the  only  New  Zcalander  who  was  privileged 
to  receive  his  services.  I  had  been  brought  to  No.  17  General 
Hospital,  Alexandria,  from  Gallipoli,  with  a  bad  wound  in 
the  right  leg.     Before  amputation  was  decided  on,  the  N.Z. 

*  On  June  2,  1915,  four  days  after  getting  to  Alexandria,  he  writes  of 
the  Graeco-Roman  museum,  that  it  has  enabled  liim  to  convert  two  of 
his  colleagues  from  inditlercnce  to  keenness  over  archaeology:  'There  is 
really  not  so  much  of  first-class  stuff  as  a  lot  of  interesting  things,  and 
some  wonderful  Greek  sculptures  small  scale,  and  larf^e  Tanagras.'  On 
June  30  :  '  Alexandria  is  of  course  extremely  interesting  as  the  place 
where  the  Ptolemies  and  the  Homans  kept  ti»c  old  Kgyptian  cult  going 
without  really  understanding  it,  and  there  arc  tombs  and  catacombs  here 
in  which  one  has  the  most  wonderful  transitional  work.  Then  on  the  top 
of  that  we  have  the  early  Xtians,  wiiosc  development  is  certainly  more 
interesting.  The  trouble  is  that  there  have  been  .so  many  wars,  out- 
breaks, etc.,  that  practically  all  Alexandria  dates  from  about  1750.  All  ^v 
the  work  is  underground.'                                                                                            ^     (. 

^1 


310  SIR  VICTOR  HORSLEY 

authorities  asked  for  a  consultation  with  Sir  Victor  Horsley. 
It  was  in  August  1915.  I  shcill  never  forget  how  cheerfully 
and  s>Tnpathetically  he  spoke  to  me.  His  presence  was  hke 
the  sunlight.  After  he  had  examined  the  wound,  he  smiled 
and  said,  '  Now  for  the  consultation,  and  I  promise  you  one 
thing — we  won't  take  away  your  character.'  I  knew  what 
he  meant,  and  think  it  was  a  channing  way  of  convejdng 
bad  news.  His  presence  and  words,  in  a  trying  and  anxious 
time  to  me,  are  a  happy  memory. 

From  Col.  Manifold,  I. M.S. 

Headquarters,  I.A.N. Z. A. C.  May  27, 1917.  .  .  .  Sir  Victor 
was  one  to  whom  the  Indian  Medical  Service  must  always 
remain  grateful.  He  was  by  no  means  carried  away  by  the 
wave  of  somewhat  indiscriminate  enthusiasm  which  in 
the  early  days  of  the  war  was  exhibited  over  the  work  of  the 
R.A.M.C.,  and  which  by  somewhat  ungenerous  and  small- 
minded  natures  had  been  exploited  to  the  detriment  of  the 
I. M.S.  when  the  two  services,  both  in  Eg^'pt  and  on  the 
Continent,  came  together.  The  same  I  heard  in  Mesopotamia, 
where  the  I. M.S.  found  him  their  best  friend.  In  Egypt, 
he  had  made  enemies  by  expressing,  with  all  that  contempt 
for  anything  that  was  not  thorough,  his  views  of  much 
that  was  faulty  in  the  arrangements  for  the  first  rush  of 
wounded  from  Gallipoli,  and  tlie  administration  in  Cairo. 
A  somewhat  amusing  experience  occurred  when  he  was  there 
in  his  rank  of  Major,  before  being  appointed  Consulting 
Surgeon  with  the  rank  of  full  Colonel.  In  one  of  the  Egyptian 
Hospitals  to  which  wounded  in  the  early  rush  from  Gallipoli 
were  sent,  and  which  hospitals  were  entirely  under  the 
charge  of  surgeons  of  Egj-ptian  nationality,  one  of  these 
latter  had  several  cases  of  severe  head-injuries  under  his 
care  ;  and  he  telegraphed  that  a  speciaUst  on  brain-surgery 
might  be  sent  from  Alexandria.  Sir  Victor  at  once  started 
off,  saw  the  cases,  and  gave  his  advice  as  to  what  was  to 
be  done  in  each  case.  The  Egyptian  surgeon  did  not  know 
the  name  and  fame  of  his  visitor,  but  was  not  at  all  satisfied 
that  the  best  had  been  done  for  his  patients  when  he  saw 
only  a  Major  in  the  R.A.M.C.  had  come,  and  one  who  from  his 
age,  he  felt,  could  not  be  a  distinguished  member  of  the 
service,  or  he  would  certainly  have  attained  a  higher  rank 
by  that  age  :  he  accordingly  wrote  in  to  the  authorities  of 
his  own  service,  stating  that  whilst  he  was  doing  his  best 
according  to  his  liglits,  he  felt  tliat  the  military  authorities 
were  not  giving  him  proper  help  and  support,  as  when  he 
had  telegraphed  for  a  brain-specialist  they  had  only  sent 
him  an  old  K.A.M.C.  Major ! 

Sir  Victor's  work  in  Egypt  was  splendid  :    and,  as  I  say. 


EGYPT  311 

he  would  have  no  good  word  ior  shams.  He  went  out  to 
Mesopotamia  against  the  wishes  anU  advice  of  men  of  tropical 
experience  who  recognised  that  he  was  not  at  his  age  fitted 
for  the  arduous  work  in  such  a  climate.  He  however  refused 
to  be  deterred,  as  he  said  he  felt  he  could  do  good,  and  recog- 
nised there  was  much  which  needed  sweeping  reform  :  a 
truthful  criticism.  The  I. M.S.  \vill  always  mourn  his  loss. 
This  is  written  hurriedly  in  the  lull  of  fighting  :  but  I  felt 
such  an  admiration  for  the  sterling  soul  in  the  man  that  I 
felt  bound  to  write. 


From  Capt.  Allen,  R.A.M.C.,  O.C.  Military  Hospital  for 
Officers,  Alexandria 

July  9,  1917.  Sir  Victor  came  out  in  June  1915,  but  as 
there  was  such  a  demand  made  by  surgeons  here  for  him 
to  see  their  head-cases  from  GaUipoli,  he  was  quickly  made 
a  consulting  surgeon.  Previous  to  his  coming  out  here,  I 
only  knew  him  on  paper,  and  had  the  idea  that  he  was  selfish 
and  difficult  to  work  with.  I  very  speedily  altered  my 
opinion.  All  the  hospitals  were  full  of  very  serious  cases 
from  the  first  landing  at  GaUipoli,  and  many  head-cases 
were  among  them.  Sir  Victor  was  everywhere.  One  was 
particularly  struck  by  the  wonderful  accuracy  of  his  prog- 
nosis, and  the  very  definite  good  results  from  his  line  of 
treatment.  He  was  a  particularly  kind  and  dehghtful  man 
to  work  with,  always  helpful  and  interesting  and  most 
generous.  If  he  had  any  spare  time,  he  was  never  idle  : 
directly  he  arrived,  he  began  to  study  the  Egyptian 
language,  and  could  soon  make  himself  understood  :  he 
possessed  a  wide  knowledge  about  things  Egyptian,  and 
investigated  everything. 

Of  course  his  personal  bravery  was  so  well  shown  by  his 
going  to  Mesopotamia  :  but  a  httle  incident  which  I  saw 
in  1915  is  worth  giving.  When  the  Arabs  (Senussi  cam- 
paign) were  fighting  at  Matruh  and  Sollam,  an  officer  in 
the  Bucks  Hussars  was  shot  through  the  abdomen  by  a 
large  Turkish  bullet.  .  .  .  They  wired  to  Alexandria  for  a 
consultant  :  Sir  Victor  was  asked  at  12  noon  if  he  would 
go ;  the  only  way  to  go  was  16  hours'  journey  by  sea 
by  a  trawler  ;  at  that  time  a  liigh  sea  was  raging,  and  it 
looked  to  mc  as  if  he  would  not  be  able  to  go  :  but  he  rushed 
home,  got  his  haversack  and  cemicra,  dashed  into  the  town 
to  buy  some  films,  and  at  2  P.M.  had  kft  Alexandria.  I 
heard  aftervsards  that  it  was  a  particularly  bad  voyage  ; 
but  he  slept  like  a  top  :  next  day  arrived  at  Matruh,  saw 
the  patient — who  eventually  came  down  to  the  Hospital 
and  recovered — visited  the  various  Field  Ambulances,  in- 


312  SIR  VICTOR  HORSLEY 

vestigated  some  Roman  remains  of  buildings,  and  returned 
in  a  trawler. 

As  you  know,  he  made  a  kind  of  walking-tour  round 
Gallipoli  :  landed  somewhere  near  Suvla,  visited  nearly 
every  Hospital  and  Field  Ambulance,  talked  and  lectured 
to  the  M.O.s  right  up  to  the  trenches,  and  was  passed  on 
to  tlie  next  unit.  Everywhere  he  was  hailed  with  dehght, 
and  I  have  frequently  met  men  who  saw  him  there  and 
testify  to  his  bravery  and  deep  interest  in  the  work.  I 
cannot  say  more  than  how  greatly  his  loss  was  felt  by  the 
Territorial  and  New  Army  doctors  :  all  felt  that  he  had  our 
interest  at  heart  :  he  recognised  the  very  great  difference 
experienced  by  men,  who  were  accustomed  to  be  regarded  as 
somebody  in  their  own  small  way,  suddenly  finding  themselves 
atoms  of  one  big  machine  :  he  did  everything  he  could  to 
encourage  them  and  keep  them  interested  in  their  work 
for  their  own  and  the  work's  sake. 


Ill 

India.    Mesopotamia 

He  reached  Bombay  on  March  25,  1916  :  visited  Delhi 
and  Simla  :  left  Bombay  on  April  9,  and  reached  Basrah  on 
April  16.  He  died  at  Amarah,  on  July  16,  in  his  sixtieth 
year. 

I 

From  Port  Said  to  Bombay.    P.  &  0.  s.s.  Arabia 

To  Lady  Horsley 

March  16.  The  Canal  is  picturesque  in  its  own  desert  way. 
Ismailya  is  a  one-horse  place,  though  the  sweet-water  canal 
enables  the  trees  to  make  a  fair  show.  The  Austrahan 
pickets  along  the  Canal  were  very  pleased  to  see  us  :  asked 
'  Where  we  were  going  to  ?  '  also  '  Is  there  a  War  on  ?  '  also 
appealed  for  '  bakscheesh  cigarettes  ' — dreadfully  mono- 
tonous life.  These  Bitter  Lakes  are  pretty  :  queer  sort  of 
trees  and  shrubs  on  the  shore  :  the  black  sandy  mountains 
in  the  background  form  the  desert  tableland  south  of  the 
road  from  Cairo  to  Suez.  The  colouring  of  the  sand  here  is 
very  good,  rich  golden  red,  whereas  that  on  the  tops  of  the 
hills  is  pale  Naples  yellow  :  water  bright  blue  of  course.  I 
am  desolated  that  you  are  not  here  for  the  rest  fulness  of 
this  sort  of  glorified  penny  steamer  trip  :  as  this  scenery 
is  so  different  to  the  Delta.  Very  few  birds  unfortunately. 
.  .  .  March  ly.  There  are  of  course  very  few  passcnjarcs  : 
a  Madras  Judge  Oldficld,  and  his  wife  who  is  a  great  pianist, 
and  I  am  going  down  at  n  to  hear  her  play  Schumann  : 
then  there  arc  one  or  two  colonels  and  oflicers  who  are  all 
revelling  in  mufti,  in  accordance  with  the  inscrutable  aiTny 
habit  of  cutting  their  profession  at  the  first  opportunity, 
a  habit  which  is  partly  accountable  for  the  prolongation  of 
the  war.  I  got  a  good  story  for  a  suffrage  meeting  out  of 
Mrs.  Oldficld.  The  native  servant  likes  brains  ;  one  was 
ordered  to  cook  a  sheep's  head  ;  when  it  turned  up  at  dinner, 
the  brain  was  absent  :  when  remonstrated  with,  he  said, 
'  Dis  one  female  sheep,  have  no  brains.'     I   am  afraid  his 

313 


314  SIR  VICTOR  HORSLEY 

unnatural  history  did  not  save  him  :  but  it  will  be  a  good 
text.  .  .  .  Practically  what  I  want  to  be  informed  about 
are  (i)  General  Politics,  (2)  Temperance,  (3)  Suffrage.  For 
(i),  the  Manchester  Guardian  and  Pioneer  are  enough.  .  .  . 

I  have  written  to ,  answering  his  pohtical  letter  and  asking 

him  to  call  when  opportunity  offers  on  the  Mayor  at  Gates- 
head to  find  out  whether  there  is  anything  in  that  move 

now.     Also  I  am  writing  to ,  asking  him  to  let  me  know 

if  he  hears  of  anything  in  the  constituency  line.     I  thought 

of  writing  to ,  but  really  I  am  not  at  all  sure  that  he 

would  help,  and  it  is  possible  that  he  would  divert  the  official 
animus  from  himself  to  me  as  a  temperance  worker.  Of 
course  too  his  employer's  venom  would  be  poured  on  my 
head  :  so  I  shall  leave  him  alone.  March  23.  Aden  was 
very  picturesque,  quite  the  mediaeval  mountain,  the  rock 
a  fine  volcanic  business  with  all  sorts  of  fantastic  shapes  and 
surfaces.  Of  course  we  had  the  usual  rot  of  not  being  allowed 
to  land,  though  we  were  there  for  six  hours  ;  very  irritating, 
as  they  have  some  cisterns  which  I  particularly  wanted  to 
see.  .  .  .  This  boat  is  distinctly  comfortable,  and  the  captain 
a  very  decent  old  bird.  I  am  wiring  you  to  say  that  it  is 
going  to  take  Lord  Hardinge  home.  Now  I  think  that  is 
good  enough  for  you  to  secure  berths  on  it,  since  we  may  be 
pretty  sure  that  they  will  escort  him  at  any  rate.  She  is 
going  to  be  scraped  too  at  Bombay  and  therefore  will  be 
able  to  do  her  17  knots.  These  ships  are  so  put  out  of  form 
that  although  you  may  find  a  good  one  in  the  list  it  does 
not  follow  she  is  clean  and  able  to  steam  her  pace  as  per  repu- 
tation. .  .  .  Do  not  forget  to  wire  me  on  the  day  you  leave, 
and  your  arrival  at  Marseilles  and  Dover  respectively. 

II 

India.     March  25 — April  9 

In  Bombay,  he  was  the  guest  of  Lord  Willingdon  at 
Government  House  : 

March  25.  This  house  and  surroundings  would  suit  you 
to  a  T  :  and  it 's  miserable  work,  your  not  being  here.  I 
am  writing  in  a  beautiful  verandah  outside  my  suite  of 
rooms  :  the  verandah  looks  out  over  the  bay  to  Bombay, 
which  now  8  p.m.  is  a  long  row  of  glittering  lights.  .  .  .  All 
the  people  very  picturesque  and  bright,  mucli  more  intel- 
lectual looking  than  the  Arabs  :  the  whole  mise-en-scene 
much  brighter  and  prettier  than  Egypt.  ...  Of  course 
unfortunately  the  servants  cannot  leave  one  alone,  and  want 
to  dress  you,  etc.,  which  is  singularly  distressing.  In  fact 
the  whole  idea  here  in  India  and  feeling  is  that  of  being 


INDIA  315 

run.  It  is  interesting  to  appreciate  the  sensation  of  an 
autocratism  and  how  completely  and  without  any  fuss  the 
idea  of  independence  and  liberty  is  quietly  destroyed.  Egypt 
is  nothing  to  it.  March  28.  A  hurried  note  is  all  I  can  do. 
The  work  here  is  really  gigantic,  and  I  shall  have  an  oppor- 
tunity in  the  train  on  Thursday,  when  I  must  go  to  Delhi 
or  Simla  to  see  the  topknots  who  require  much  help  to 
wisdom.  Froom  very  kindly  has  reserved  you  a  3-berth 
cabin  on  the  port  side,  which  is  the  side  I  came  out  on. 
The  Arabia  is  very  comfortable  and  an  extraordinarily 
steady  boat  in  a  choppy  sea.  The  only  thing  that  worries 
me  is  w'hether  you  will  have  got  my  wires.  .  .  . 

Delhi,  March  31.  Here  we  are  in  the  Commander-in- 
Chief's  house — Sir  Beauchamp  Duff.  He  was  very  friendly  : 
but  as  unfortunately  the  Viceroy  is  leaving,  and  he  is  moving 
his  office  to  Simla  for  the  hot  weather,  he  says  we  must 
travel  up  there  to-night  with  him  to  get  sufficient  time  to 
talk  things  over  with  the  D.M.S.  I  am  afraid  it  is  partly  the 
Indian  leisurely  way  of  doing  things.  ...  I  hope  to  see  the 
hospital  here  this  morning,  if  there  is  one  for  the  war,  and 
in  any  case  the  Station  hospital,  then  run  round  the  Fort 
and  the  chief  Mosques.  They  lose  a  lot  of  time  here,  and 
the  distances  are  of  course  considerable.  The  journey  was 
very  interesting,  because  when  we  woke  up  at  7  we  were 
already  in  the  plains  running  through  a  bare  sandy  country 
covered  with  a  feeble  forest  ;  trees  every  20  yards,  half- 
dead,  and  no  leaves  anywhere :  the  leaves,  having  the 
decency  to  remember  it  is  really  winter,  have  dropped  off, 
and  are  only  now  beginning  to  sprout  again.  The  natives 
were  cheerfully  encouraging  their  herds  to  graze  on  what 
appeared  to  be  nothing  at  all  :  and  it  was  only  now  and 
then  that  the  traces  of  cereal  culture  explained  why  they 
were  in  any  condition  at  all  except  bones.  Some  700 
mUes  from  Bombay,  the  old  hill  forts  of  the  Mahrattas  came 
in  sight  :  the  plain  they  looked  over  is  anything  from  30 
to  loo  miles  before  you  come  to  another  little  range. 
.  .  .  The  costumes  are  good  :  the  young  ladies  until  they 
come  out  are  fully  attired  in  blue  bead-nccklaccs,  gold  nose- 
ring, and  a  pair  of  bags  literally  :  but  they  do  not,  of  course, 
look  in  the  least  like  savages,  as  my  scrawl  suggests,  because 
tlu'V  have  so  much  refinement  of  carriage.  .  .  .  Lord 
Willingdon  was  most  interesting  about  India,  and  is  obviously 
doing  first-rate  work  on  the  progressive  line ;   more  so  than 

,  who  is  doing  the  usual  thing  of  saying  we  must  go  slowly. 

Considering  the  utter  conservatism  of  India,  naturally  this 
is  absurd  beyond  measure.  Naturally  he  is  hampered  by 
money  considerations.  It  seems  to  me  that  the  rwiancial 
people  here  are  thoroughly  asleep  and  not  rising  to  the  fact 
of  War  at  all. 


3i6  SIR  VICTOR  HORSLEY 

Bombay,  April  4.  We  arrived  just  now  from  Simla  :  2200 
miles  in  5  J  da^^  :  not  bad  going.  Am  very  fit  in  spite 
of  considerable  heat  and  unspeakable  dust. 


Ill 

Front  Bombay  to  Basrah.     Hospital  skip  Sicilia 

April  9.  I  was  horrified  to  find  in  your  letter  you  pro- 
posed going  2nd  class.  It  is  quite  impossible.  I  got  the 
berths  for  you  on  the  best  side  of  the  ship  and  close  to  the 
boats.  Under  no  circumstances  could  you  go  second.  I 
found  on  the  Arabia  that  she  was  immediately  dry-docking 
to  scrape  and  buck  her  up,  so  that  you  could  not  be  in  a 
better  ship  as  far  as  that  goes.  Then  also  she  is  extraordin- 
arily steady.     As  regards  ,  it  would  be  nothing  to  us 

to  pay  the  difference  in  her  case,  so  as  to  keep  the  party 
together.  ...  On  board  we  have  Col.  Blenkinsop  in 
charge,  and  five  medical  officers  and  four  sisters,  also  Mr. 
Ridsdale  :  he  is  a  greyish  artistic-looking  man  who  is  out 
here  to  organise  the  Red  Cross  business  properly,  and  has 
brought  out  800  cases  of  stores  from  somewhere.  He  is 
a  very  decent  chap  and  I  hope  to  foregather  with  him 
to-morrow.  At  present  things  are  looking  up,  accord- 
ing to  the  telegrams  :  but  what  our  muddled  plans  really 
will  be  goodness  knows,  though  I  imagine  that  we  must 
go  to  Bagdad  to  adequately  settle  the  occupation  of  the 
country.  If  so,  then  there  will  be  considerable  need  for  him 
and  his  stores,  because  the  Indian  Government  officials  are 
playing  the  extraordinary  game  of  pretending  that  India  is 
not  at  war.  Result,  chaos  of  course  :  but  what  is  worse  is 
that  organisation  preparations  which  should  be  on  a  war  scale 
are  made  on  a  peace  one.  Hence  overwork,  discontent,  and 
non-fulfilment  of  duties,  etc.  Lord  and  Lady  Willingdon  were 
certainly  exceptional  people.  He  of  course  was  Liberal 
member  for  Hastings.  If  it  had  not  been  for  the  Willing- 
dons,  who  organised  a  kind  of  Red  Cross  which  they  called 
the  Women  of  India's  Branch,  and  furnished  the  troops 
with  absolute  necessaries,  e.g.  shirts,  socks,  etc.,  the  Govern- 
ment's course  would  have  left  them  to  welter  in  the  extreme 
hardships  of  this  campaign.  As  it  is,  of  course,  very  little  has 
been  done  in  reahty  for  the  men.  Whisky  every^vhere.  .  .  . 
We  returned  from  Simla  the  day  on  which  Chelmsford 
arrived  and  Hardinge  left.  Therefore  nothing  much  could 
be  done  in  Bombay,  because  although  the  natives  take  very 
little  interest  in  the  doings  of  the  Viceroy,  etc.,  the  streets 
are  lined  with  police,  etc.,  as  if  large  cheering  crowds  were 
expected.  Of  course  the  Parsees  turn  out  more  or  less, 
because  they  are  the  most  cosmopoUtan  of  this  congeries  of 


INDIA  317 

races ;  and  the  wealthy  Hindoos,  of  whom  there  are  a  fair 
number.  Motor-cars  everywhere.  The  next  day  I  harangued 
the  medical  students,  men  and  women  together,  at  the  Grant 
Medical  CoUege,  and  got  in  the  usual  points.  I  think  it 
was  interesting  to  them,  and  beheve  it  has  stirred  up  all 
sorts  of  people  in  authority  to  think  about  things  and 
especially  the  alcohol  question  a  little  more.  I  have  found 
a  fearful  condition  of  slackness,  bad  equipment  everywhere. 
Due  to  the  utter  fear  of  the  finance  people  and  infamous  system 

worshipped  by  .     The    Indian  Government   appointed 

a  Commission  to  enquire  into  Mesopotamia :  wiiat  they 
want  is  an  enquiry  into  the  whole  of  their  medical  business. 
Of  course  our  people  (the  medical  profession)  are  to  blame 
also.  They  have  deliberately  gone  on  with  shockingly  in- 
ferior means,  actually  saying  that  they  did  '  pretty  well.'  .  .  . 
At  any  rate,  the  ridiculous  Commission  now  enquiring,  which 
consists  of  a  Major-General  Bingley  and  a  Mr.  Vincent,  a 
Civil  Service  man  having  no  medical  knowledge  whatever, 
have  no  means  of  getting  at  the  truth. 

April  15.  Rolling  off  the  bar.  We  could  have  got  a  pilot 
from  the  lightship  :  but  no  :  lay  to  until  the  Syria,  the 
corresponding  ship,  came  down  :  and  took  her  pilot  back. 
By  that  time  of  course  it  was  too  late  :  not  enough  water  : 
so  we  stuck,  and  only  with  great  difficulty  got  back  into 
deep  water,  where  we  are  now  lying  and  shall  remain  till 
to-morrow  morning.  Thus  a  whole  day  has  been  lost  by 
ultra  folly.  Nobody  seems  to  care.  All  this  apathy  is 
simply  chronic  stupidity  of  whisky  drinkers.  .  .  . 

When  1  return  to  India  I  shall  go  all  through  it  [the  adminis- 
tration of  the  Indian  Medical  Service]  to  see  the  whole 
working  and  scheme,  to  see  if  possible  how  it  can  be  righted. 
Above  all  to  find  out  where  the  financial  difhculty  really 
lies.  Of  course  it  is  fundamentally  clear  that  the  whole 
service  is  starved,  and  that  the  medical  officers  have  been 
terrorised  into  incapable  indifference.  They  think  in  terms 
of  cost,  and  not  of  scientilic  care  of  their  patients'  interests. 
The  extreme  difficulty  is  to  find  out  where  the  obstruction 
lies,  whether  inside  the  I. M.S.,  i.e.  in  their  accountants' 
department,  or  at  the  Viceroy's  Council,  i.e.  in  the  Finance 
Department.  ...  To  make  matters  worse,  the  Commission 
which  enquired  into  the  Civil  Service,  etc.,  has  not  reported 
and  will  not  till  well  after  the  War.  I  cannot  find  from  any 
of  the  men  here  what  evidence  they  put  up  :  so  that  avenue 
of  information  seems  small  enough.  Perliaps  I  can  put  it 
riglit  in  Mesopotamia  :  there  must  be  stacks  of  I. M.S.  men 
there.  It  really  is  a  very  interesting  constitutional  question, 
this  financial  control,  quite  a  chapter  in  itself  because  so 
fundamental.  Matters  of  principle  are  always  worth 
hundreds  of  detail. 


3l8  SIR  VICTOR  HORSLEY 

To  Col.  McCarrison,  I. M.S.,  Alexandria 

April  12.  I  found  at  Bombay  that  the  A.D.M.S. 
was  an  old  friend  :  Col.  VVanliill,  who  was  at  Univ. 
Coll.  Hosp.  He  of  course  was  very  helpful:  but  above 
all  General  Knight,  who  commands  the  I3ombay  Brigade, 
and  who  poor  man  was  being  obliged  to  run  the  one  port, 
through  which  the  whole  war  is  being  conducted,  on  a  peace 
footing.  I  never  heard  of  such  fatal  views  as  to  how  to 
run  a  war.  I  arrived  25.3.16.  After  seeing  the  hospitals 
and  base  stores  I  was  so  appalled  I  talked  to  Knight  :  and 
having  settled  I  must  see  the  D.M.S.  to  regularise  my  posi- 
tion out  here,  I  suggested  I  could  hang  on  to  the  visit  all 
my  ideas  on  these  points  and  urge  immediate  reforms. 
Knight,  who  was  as  keen  as  mustard,  went  one  better,  and 
insisted  on  my  going  to  Delhi  and  seeing  the  Cder.  in  Chief 
as  well.  Arrived  Delhi :  C.  in  C.  said,  '  I  am  going  to  Simla  : 
run  round  Delhi  in  motor  '  :  which  I  did  and  saw  everything, 
though  hurriedly :  went  in  evening  with  C.  in  C.  to  Simla  : 
at  Kalka,  got  into  his  car  and  motored  up  the  58 
miles.  Wonderful  ride  :  most  people  made  seasick  by  the 
comers.  .  .  .  He  was  extremely  kind  to  me  and  talked  all 
these  points  for  36  hours.  I  think  I  helped  him  '  some,' 
at  any  rate  he  said  I  did,  and  wants  me  to  cable  ideas 
direct  to  him.  ...  Of  course  the  fatal  error  has  been  here 
as  in  Egypt  :  the  Govt,  has  not  recognised  that  these  coun- 
tries are  non-productive.  Why,  I  find  they  cannot  even 
repair  or  sharpen  surgical  instruments,  and  as  to  ordinary 
equipment  it  simply  is  not  in  the  country  at  all.  I  have 
suggested  what  could  be  made  by  energetic  shoving,  but  a 
corps  of  hustlers  is  badly  wanted.  I  left  Simla  in  a  motor 
car  on  railway  wheels  :  bowled  down  the  line  delightfully. 
Continued  at  Bombay  the  struggle,  with  more  result  :  and 
fm.'dly  left  on  9.4.16  Sunday  midday.  Things  are  shaping 
but  there  will  have  to  be  a  complete  reform  and  a  powerful 
enquiry  at  the  end  of  the  War.  In  the  meantime  I  urged 
on  the  C.  in  C.  to  draw  materiel  and  personnel  from  Egypt 
where  it  was  doing  nothing.  I  beheve  he  is  following  this 
advice. 

IV 

Mesopotamia.     April   16- July  16 

To  Lady  Horslcy 

Ashar,  April  19.  Goodness  knows  when  you  will  get  this, 
as  I  am  just  told  letters  posted  to-night  go  by  next  week's 
mail  !  That  is  a  loss  of  a  week  to  start  with.  Then  to 
Bombay  six  days,  then  Lome  three  weeks  :    probably  five 


MESOPOTAMIA  319 

altogether.  Certainly  the  Indian  organisation  all  round  is 
astounding.  After  aU  the  ideas  we  had  about  the  constant 
efficiency  of  the  Indian  military  system.  Another  delusion 
gone.  Now  is  the  momeni:  (one  hour  only)  to  give  you  some 
idea  of  this  place.  The  Tigris  as  we  ascended  it  for  about 
60  miles  is  a  broad  yellow  river  with  very  picturesque 
creeks  and  date-groves  innumerable.  The  cultivated  strip, 
like  Eg>'pt  (Upper),  is  very  narrow  owing  to  centuries  of 
militarism  and  destructive  invasions.  The  whole  country 
requires  reorganisation,  and  then  the  wretched  inhabitants 
will  have  some  chance  of  raising  themselves  out  of  savagery. 
Basrah  itself  I  have  not  yet  seen,  as  the  inspection  work  is 
very  heavy,  and  still  more  the  writing  notes  and  copies  of 
the  documents  which  show  the  actual  work  of  the  place 
medically  for  the  last  year  :  the  town  we  are  Uving  in  is 
really  called  Ashar,  It  is  just  hke  the  squalid  Arab  to\sTi 
anywhere  :  mostly  built  of  yellow  flat  Roman  bricks,  and 
mud-huts  galore.  Our  people  have  policed  and  cleaned  it 
into  more  or  less  respectabilit}'  :  but  of  course  it  is  smells 
and  dust  and  dirty  people  all  through.  .  .  .  The  house  was 
built  b}'  a  pious  Islamite  as  a  rest-house  for  pilgrims  (there 
are  a  vast  number  of  holy  places  up  the  Euphrates,  and  a 
tremendous  business  done  in  pilgrims).  He  is  buried  in 
the  floor  of  the  room  marked  x  :  I  have  indicated  his  grave 
also.  Fortunately  this  was  two  years  ago  or  more,  so  there 
is  no  odour  of  sanctity  about  him  like  Appleby  church. 
The  whole  real  traffic  of  the  place  is  done  not  by  roads  and 
paths  so  much  as  by  '  bellums  '  :  these  are  exactly  like  dug- 
outs, narrow  and  tituppy  gondolas,  with  two  Arabs  in  full 
costume  poling  and  cursing  every  one  they  meet.  In  the 
main  stream  and  up  the  creeks  are  wonderful  '  mahclalis  '  ; 
these  are  large  trader  boats  ;  a  solitary  Arab  squats  on  the 
tiller,  perched  up  hke  a  mediaeval  ship.  Then  in  the  fair- 
way are  anchored  all  the  ocean-going  steamers  which  draw 
not  more  than  18  feet  and  can  get  over  the  bar.  All  this  is 
very  picturesque  :  inlinitely  more  so  than  Eg\'pt.  Of  course 
the  discomforts  are  enormous,  chiefly  and  wlioUy  owing  to 
our  own  unspeakable  folly,  stupidity,  and  criminality.  Au 
enormous  amount  has  to  be  done,  and  now  is  being  done, 
I  hope.  I  have  discussed  everything  here  too,  and  I  think 
with  the  same  success  as  in  India.  One  most  importimt 
change  I  urged  at  Simla  has  been  already  made  :  so  I  am 
hoping  for  more. 

I  must  take  this  round  the  swamps  to  the  P.O.  The  frogs 
here  chirp  like  the  thousands  of  sparrows  roosting  in  the 
Mahomet  Ali  Square  :  and  I  am  glad  to  sec  in  the  swamps 
fish  which  eat  the  mosquito  larva*,  but  of  course  only 
'  some.'  The  blue  jay,  a  lovely  bird,  is  common  ;  also  a 
bird  that  sings  like  a  tiirush  ;  so  there  's  plenty  to  sec. 


320 


SIR  VICTOR  HORSLEY 


To  his  Daughter 

Basrah,  April  23.  .  .  .  It  was  a  great  contrast  to  come 
from  all  the  large  scale  work  [Bombay  and  Delhi]  to  this 
curiously  savage  hole.  The  people  here  are  mostly  Arabs 
of  the  conventional  type,  but  very  wild  and  savage-looking 
for  the  most  part,  as  if  they  had  combined  a  hard  struggle 
for  existence  with  chronic  piracy  and  a  dash  of  murder  in 
it  now  and  again.  One  of  the  engineer  subs  here  was  sent 
up  the  river  some  70  or  80  miles  in  a  large  launch  to 
assist  a  grounded  barge.  When  he  got  there  and  tied  up, 
he  heard  a  '  loud  noise.'  and  discovered  that  the  rival  Arab 
tribes  of  the  district  were  having  their  annual  battle.  So 
many  volleys  poured  over  his  head  that  he  moved  down  until 
the  battle  was  over.     Next  day  they  were  all  at  work  again. 

This  is  '  unrest,'  a  disease 
which  is  practically  physio- 
logical not  pathological  to 
these  people.  Of  course  they 
are  gloriously  lazy.  Owing  to 
the  high  rudder  and  tiller,  one 
gentleman  I  saw  this  morning 
steering  with  his  head,  so  he 
could  sit  still  and  enjoy  life. 
There  are  some  industrious 
people  here  who  on  the  con- 
trary seem  always  at  work  :  I 
don't  know  what  they  are,  but  possibly  Persians.  The  small 
mosque  here  .  .  .  the  interior  was  very  impressive,  because 
it  had  pointed  arches  and  four  enomious  pillars  about  10 
feet  in  diameter,  while  by  the  side  of  the  Kibla  was  the 
pulpit,  like  that  of  a  refectory,  in  the  wall,  and  with  a  Httle 
Early  English  arch  over  it.  The  old  caretaker  Muezzin 
person  was  greatly  pleased  with  my  appreciation  of  it,  and 
so  also  the  20  idle  cutthroats,  who  were  most  respectful 
when  I  took  my  boots  and  gaiters  off,  and  accompanied  me 
round  to  see  all  fair. 


To  Lady  Horslcy 

Basrah,  April  25.  ...  I  have  imearthed  a  terrible  number 
of  things  ;  have  cabled  twice  to  Simla  and  once  to  Keogh 
already.  The  Commission  here  enquiring  into  the  medical 
arrangements,  and  with  no  medical  man  on  it,  is  going  along 
in  its  futile  way.  In  consequence  of  what  I  saw  in  India,  I 
ultimately  cabled  to  know  if  the  field  dressings  were  sterilised, 
and  received  the  staggering  reply  No.  Of  course  I  cabled 
immediately  that  it  should  be  done,  smd  have  written  as 


MESOPOTAMIA  321 

well.  It  never  entered  into  my  head  for  a  moment  but  that 
they  were.  .  .  . 

About  40  miles  below  Aviarah,  April  27.  We  sailed  in 
due  course  yesterday  morning  on  the  little  hospital  boat, 
and  slept  in  one  of  the  cots  under  the  awning.  After  Quma, 
we  entered  the  great  marshes  which  extend  for  about  50 
miles  on  each  side  of  the  river.  Quma  is  the  place  where 
the  tree  of  knowledge  grew  (at  the  apex  of  the  Garden  of 
Eden)  :  unfortunately  the  top  was  blown  off  the  other  day, 
and  it  now  is  hke  this,  standing  on  the  quay  with  a  mud- 
wall  behind  it  and  the  rough  encampment  of  the  stores  of  a 
miUtar}-  post  of  Sikhs.  The  inhabitants  and  cattle  are  in 
and  out  of  the  water  all  day,  consequently  the  men  towing 
the  big  trade-boats  imitate  Adam  faithfully.  The  small  boys 
who  are  innumerable  and  who  hurry  to  the  bank  expecting 
donations  of  biscuits  and  scraps  from  the  Tommies  arc  given 
the  head-dress  and  a  few  feet  of  stuff  for  a  galabca  :  the 
results  are  too  comic  :  every  stage  in  the  evolution  of  a 
complete  costume.  .  .  . 

The  bird  Hfe  is  very  pleasant.  Large  numbers  of  herons 
of  all  sizes,  black  and  white  large  crows,  and  innumerable 
kingfishers  :  great  colonies  of  the  common  (in  the  East) 
black  and  white  kingfisher,  greyer  than  the  Egyptian  one 
and  very  cheerful  :  chirps  about  all  over  the  place  :  and 
this  morning  very  early  they  were  sitting  on  every  bush  and 


lump  at  the  water's  edge,  waiting  for  their  breakfast  to  come 
along  :  they  were  in  pairs,  like  Darby  and  Joan,  one  looking 
up  stream  the  other  down,  so  as  to  miss  nothing.  Every 
available  bank  was  full  of  their  nesting  holes.  They  have 
no  fear  of  the  boat.  Other  occupants  of  the  banks  are  turtles, 
who  cock  their  heads  up  like  bitterns,  and  as  you  see  them 
at  the  Zoo.  They  had  for  the  most  part  no  intentions  of 
going  into  the  soup-tureen,  and  so  gently  slid  off  into  the 
water  when  we  really  got  within  hail.  .  .  ,  Yesterday  I  saw 
at  least  a  dozen  greater  bitterns,  like  the  one  we  saw  at  St. 
John's  lake,  but  larger.  It  was  a  great  pleasure  to  see  it, 
as  it  is  nearly  extinct  in  Lincolnshire. 

We   tied   up   for^  the  night   about  3  miles   below  Ezra's 

X 


322  SIR  VICTOR  HORSLEY 

tomb.  This  is  a  most  charming  tomb,  nominally  of  Ezra, 
who  said  he  was  to  be  buried  near  the  sea,  so  they  worked 
down  the  river  till  they  came  to  where  a  tide  was  just 
perceptible,  so  they  decided  it  must  be  the  sea,  and  popped 
him  underground.  Jolly  glad,  I  expect,  not  to  go  another 
step  with  the  old  gentleman.  The  dome  was  a  beautiful 
blue  enamel,  with  a  little  crown  of  simple  diaper,  and  the 
neck  of  yellow  bricks  with  more  diaper,  and  the  whole 
thing  surrounded  by  a  delicately  arcaded  wall  and  palm-trees. 

At  the  Front,  April  30.  The  question  now  is  what  is  going 
to  be  done.  At  present  we  are  close  (2  miles)  to  the  tiring 
hne,  and  it  remains  to  be  seen  whether  the  Turks  will  come 
on  or  not.  After  we  left  Amarah,  we  had  a  disagreeable 
incident  :  a  man,  a  stoker,  either  fell  or  jumped  overboard  : 
and  though  he  tried  to  swim  to  the  bank,  he  was  carried 
away  in  the  swirling  current  and  drowned.  This  river  is 
a  boiling  stream  of  pea-soup,  and  though  a  fine  waterway 
needs  a  lot  of  attention.  We  met  corpses  of  men  and  horses 
floating  down  our  druiking  water  :  and  on  the  nmd  banks 
was  a  huge  tarpon,  quite  7  feet  long,  and  some  shark-like 
fish  higher  up,  killed  I  suppose  by  a  shell  exploding  in  the 
water.  This  country  of  course  is  most  forbidding.  Nothing 
but  flat  ground  covered  with  rough  grass  and  camelthom. 
I  am  writing  this  outside  the  mess-tent  of  the  24th  Indian 
Field  Ambulance,  where  we  have  fortunately  got  in.  I 
drew  tents  at  Bombay  luckily  :  and  when  we  arrived  here 
we  had  to  camp  on  the  river  bank,  ht  a  fire,  and  dined  sump- 
tuously off  tea,  biscuit,  and  horribly  salt  bully  beef.  The 
insect  Ufe  here  would  drive  you  screaming  mad.  On  the 
hospital  ship,  the  last  two  nights,  directly  the  lights  were 
turned  up,  we  were  invaded  by  millions  of  flying  beetles. 
The  table,  food,  heads,  faces  and  hands  covered  with  a  thick 
swarm,  including  enormous  black  beetles.  The  only  thing 
to  do  was  to  cat  like  mad  and  turn  out  the  lights.  They  got 
into  the  beds  and  felt  like  old  cnnnbs  and  grit.  Fortunately 
they  none  of  them  really  bit.  They  only  got  annoyed  when 
entangled  in  your  hair,  when  they  sometimes  in  sheer  worry 
I  suppose  held  on  with  nippers.  My  mosquito  curtain  so 
far  has  done  wonders,  and  I  was  only  bitten  once  at  Basrah, 
by  sitting  writing  at  dusk.  Most  people  have  suffered  from 
sand-fly  :  so  far  I  am  all  right  too,  so  the  net  must  be  a 
good  one.  The  flics  of  course  are  very  bad.  This  camping 
ground  has  had  many  horses  over  it :  and  last  night  the  Anny 
Corps  sanitary  staff  with  which  we  camped  actuaUy  moved 
on  to  old  cavalry  ground.  I  never  saw  such  stupidity.  Fortu- 
nately now  we  have  got  into  an  ambulance  camp  which  is  on 
good  dry  clean  ground,  and  shall  stop  as  long  :is  1  remain  here. 

I  have  inspected  four  ambulances  so  far  already,  and  hope 
to  do  the  front  line  and  the  others  during  the  next  four  days, 
but  it  is  slow  work  owing  to  the  lack  of  transports  and  extra- 


MESOPOTAMIA  323 

ordinarily  nasty  climate.  Everybody  is  very  kind  :  but  the 
starvation  policy  and  methods  of  the  Indian  Govt,  are  terrible 
and  only  exceeded  by  the  hes  in  the  House  of  Commons. 

Shaik  Saad,  May  5.  I  came  down  here  because  nothing 
was  doing  at  the  front,  and  tliis  place  is  designed  to  develop 
medically  hke  Amarah.  It  is  wlicre  one  of  the  very  worst 
fights  took  place,  and  disgraceful  conditions  to  which  the  sick 
and  wounded  were  subjected,  with  torrential  rains  on  the 
top  of  it  all.  It  consists  of  Arab  mud-houses,  in  one  of  which 
I  have  a  room  :  which  has  been  remudded  and  petroleumed, 
so  it  is  very  comfortable.  We  have  an  amusing  puppy, 
cocks  and  hens,  swaUows,  and  sparrows  and  cats  in  the  little 
farmyard,  and  in  my  room  when  they  are  so  disposed,  so 
there  's  no  lack  of  company.  I  am  staying  in  a  very  nice 
mess,  that  of  the  6ist  Indian  Stationary  Hospital,  commanded 
by  Major  Goodbody,  I. M.S.,  very  successful  and  popular, 
running  the  show  with  great  acumen  and  aplomb.  His  staff. 
Indian  and  British,  are  also  very  efficient  and  pleasant,  so 
we  are  on  our  feet  as  usual.  ...  I  had  to  walk  in  the  morning 
about  ten  miles  out  and  back  to  visit  some  cavalry  and  other 
field  ambulances  :  but  so  far,  though  the  heat  is  curiously 
burning,  it  is  not  so  exhausting  as  might  be  thought,  if  you 
drink  a  fair  amount  of  (boiled)  water.  One  of  the  horrible 
laches  of  this  business  is  that  the  lighting  men  are  not 
even  yet  adequately  suppUed  with  water.  I  see  Austen 
Chamberlain  said  in  the  House  that  probably  an  enquiry 
will  be  held.  If  so,  I  hope  and  pray  that  I  shall  be  allowed 
to  give  evidence.  The  bogus  Commission  out  here  now  may 
possibly  furnish  a  confidential  report,  as  they  were  appointed 
departmentally,  but  I  gather  Chamberlain  meant  a  large 
affair  when  we  all  come  home  again. 

Of  course  the  inevitable  alcohol  is  always  cropping  up. 
This  force  drinks  far  less  than  the  Egyptian  one.  Tlie  large 
majority  of  this  mess  are  regular  teetotallers,  and  at  lunch 
to-day  five  out  of  nine  present  were  non-smokers.  ...  A 

typical  case  is  that  of  the  here.     Some  six  weeks  ago, 

when  the  men  were  really  half-starved  and  getting  the  old- 
fashioned  rations  with  the  result  that  scurvy,  diarrlirca, 
and  beri-beri  are  relatively  common  events,  the  extremely 
precious  steamer-room  was  takt^n  up  by  enormous  and 
numerous  cases  of  champagne,  port,  whisky,  etc.,  for  the 
officers'  mess.  This  morning  I  f(jund  that  in  that  one 
regiment  alone  46  men  reported  sick,  and  the  rest  an- 
languid,  tired.  Of  course  because  of  the  wicked  neglect  of 
the  water  we  have  sporadic  cases  of  cholera  in  every  camj) 
practically,  though  if  the  water  is  boiled  there  is  no  danger. 
Of  course  the  habitual  whisky-drinker  thinks  it  sterilises 
the  water  and  he  doesn't  care  anyvvay  but  clianccs  it.  .  .  . 

I  am  hard  at  work  here  tr\'iiig  to  get  the  surgical  conditions 
improved  ;    it  is  haid,  seeing  that  every  clcmcutaxy  rule  of 


324  SIR  VICTOR  HORSLEY 

sanitation  is  avoided  (not  necessarily  evaded)  and  there  is 
no  medical  ofticer  except  Goodbody  who  dares  take  a  strong 
line  to  protect  his  patients  :  and  as  for  the  administrative 
officers,  it  seems  as  if  their  one  idea  is  how  to  get  the  poor 
fellows  away  rather  than  how  to  protect  them  from  the 
commonest  evils.  Of  course  they  themselves  arc  paralysed 
because  the  chief  command  has  never  provided  transport  of 
ordinary  materials,  let  alone  engineering  materials  for  water 
supply,  etc.  But  here  the  catalogue  is  endless.  Suffice  it 
to  say  that  everything  wants  looking  into.  If  it  had  not 
been  for  the  War  Oflicc  letter  of  June  1915,  I  could  hardly 
have  done  a  stroke  of  work  except  by  sheer  bluff.  I  had 
better  shut  up,  as  I  am  drafting  memos,  and  they  take  such 
a  time.  PS. — An  O.C.  of  an  infantry  regt.  has  just  sent  in  to 
see  me  about  conditions  I     This  is  instructive  ! 

Shai/i  Saad,  May  15.  .  .  .  Real  swelter,  last  two   days  : 
108-110  in  shade  :  with  exquisite  moonlight  nights.     Packing 

a  small  bag  makes  you  stream. 
The  grasshoppers  are  enormous 
here, like  locusts  but  less  stomach, 
like  Huxley's  real  lover  the  male 
Rotifer.  They  stroke  their  noses 
like  cats.  This  is  his  actual 
size,  but  they  are  not  like 
locusts,  though  the  largest  have 
wings.  They  are  very  friendl}', 
quite  unUke  the  flies,  which 
adopt  every  known  means  of 
biting  you.  Yesterday  a  very  handsome  person  in  the  shape 
of  a  tarantula  sort  of  spider,  with  wonderful  shirt  and  waist- 
coat of  white  and  light  chocolate  stripes,  arrived.  We  en- 
couraged him  in  the  hope  he  would  dine  off  the  various  other 
visitors.  He  was  evidently  well  anned,  as  he  displayed  no 
emotion  at  our  presence.  There  is  no  doubt  the  Army  and 
Navy  mosquito-net  is  very  good  :  I  have  watched  from  the 
inside  lots  of  sand-flies  using  dreadful  language  on  the  out- 
side because  they  couldn't  get  in  :  and  my  numerous  bites 
are  all  acquired  in  the  evening  before  I  can  make  tracks  for 
my  little  bed.  The  quinine  every  day  prevents  any  of  the 
biters'  attentions  in  the  way  of  fever.  ...  I  see  that  in  the 
House  of  Commons  the  people  are  being  fooled  to  the  top 
of  their  bent.  There  is  no  medical  transport  of  the  sick 
and  wounded,  except  one  small  steamer.  They  are  still 
brought  down  in  stinking  filtliy  store-barges,  very  often  with 
no  water-tank,  and  never  more  than  one  foul  latrine.     It 

really  is  incredible  until  you  have  seen  it.     That  liar 

said  there  was  ice  and  fans  in  the  hospitals.^     I  believe  there 

*  A  statement  to  this  effect  had  been  made  in  the  House  of  Commons 


MESOPOTAMIA 


325 


is  ice  at  Basrah,  but  we  are  over  300  miles,  and  the 
hundreds  of  patients  here  and  everywhere  above  Amarah 
have  no  beds  even.  Cholera  patients  lie  on  ground  or  on 
stretchers.  How  these  scandalous  falsehoods  are  concocted 
I  cannot  imagine.  The  enquiry  will  have  to  find  that  out. 
I  do  hope  the  fall  of  Kut  has  been  taken  up  by  the  public  : 
but  I  suppose  it  is  limited  to  '  our  sympathy  goes  out  to 
the  gallant  men,'  etc.  etc.  May  16.  I  had  hoped  to  get 
down  to  Amarah  to-day,  but  no  boat  has  yet  arrived.  The 
new  D.M.S.,  Treheme,  is  coming  up  to  Amarah  to  discuss 
with  me  the  transit  of  '  surgical  cases.'  Willcox  has  also 
arrived,  and  is  coming  up  with  him.  As  I  see  no  increase 
of  transport  during  this  month,  there  is  no  chance  of  a  proper 
medical  service.  What  lines  the  discussion  therefore  will  take 
heaven  knows.  Even  here  at  Shaik  Saad,  where  a  great 
medical  station  is  designed,  we  cannot  settle  anything  because 
the  corps  Staff  will  not  issue  any  precise  orders  on  the  move- 
ment and  constitution  of  the  units.  I  have  drawn  out  fully 
what  the  units  will  require  in  the  way  of  equipment,  and 
left  it  with  the  active  O.C.'s  here  while  I  go  to  Amarah  : 
but  suspect  I  shall  be  back  again  in  two  or  three  weeks, 
unless  the  Turks  cut  us  all  off  and  take  us  to  Constantinople 
like  brother  Townshend. 

Just  been  on  the  roof  like  Sister  Anne  to  see  if  any  boat  is 
in  sight.    '  Answer  in  the  negative.'     Was  greeted  on  arrival 


by  a  cow  on  the  roof  of  the  next  house  :  and  she  proceeded 
to  walk  up  the  '  street  '  irom  roof  to  roof.  .  .  .  They  have 
large  coracles  here,  which  carry  up  to  ten  tons.     Thurston 


siiw  one  towed  by  a  mare  swinuuing  wiiile  the  foal  w;ls  on 
board,  thus,  and  the  Arab^  jjaddlcd  to  steer.     Had  to  break 


326  SIR  VICTOR  HORSLEY 

off,  as  Col.  Acland  Troyte,  commanding  the  Devons  here, 
came  to  settle  tilings,  having  written  the  enclosed  amiable 
letter.     Must  shut  up  and  wash  for  dinner. 

Amur  ah.  May  21.  As  there  is  a  layer  of  fluid  all  over 
one's  body  all  day  and  night,  it  is  difficult  to  write  except 
on  a  folded  handkcrciiief  as  a  guard.  I  shall  stop  here  until 
something  definite  occurs  at  the  front.  .  .  .  What  to  do 
God  knows,  as  everything  is  wrong  here,  and  nothing  but 
astounding  work  in  India  and  at  home  can  possibly  put 
things  right.  I  tnist  my  telegrams  to  the  Commander-in- 
Chief  and  the  D.M.S.  have  started  the  ball  rolling,  because 
they  have  wired  to  say  that  more  M.O.'s,  etc.,  are  coming 
from  Egypt  as  I  suggested.     Also  material. 

Amarah  is  quite  a  picturesque  comer  of  the  river.  The 
river  is  quite  250  yards  broad,  and  a  powerful  current  at 
the  comer,  where  the  stream  divides.  The  date-groves  on 
the  other  side  of  the  river  are  very  pretty,  with  undergrowth 
and  large  flowers  growing  6  feet  high.  We  used  to  have 
them  at  WiUesley.  At  a  distance,  they  might  be  taken  for 
true  hollyhocks,  but  they  are  nothing  like  them  really,  and 
at  home  they  only  grew  about  2  feet  high.  The  flower  is 
like  a  Xmas  daisy.  The  nightingale  was  singing,  not  so  well 
as  at  home  and  much  less  continuous.  These  coppices  are 
being  made  into  convalescent  places  for  officers,  and  on  the 
outskirts  only,  I  fear,  for  tlie  men.  We  went  across  in  the 
usual  gondola,  which  is  rougher  here,  and  held  by  enormous 
nails  like  a  Turkish  door.  That  reminds  me — the  tympana 
of  the  doors  here  are  full  of  diaper  work  which  is  exactly 
Norman,  i.e.  ours  :  I  suppose  post-crusadal.  .  .  .  Treheme 
seems  to  be  aware  of  the  follies  and  crimes,  and  simply  is 
here  to  try  and  smooth  things  out.  Lord  knows  where  you 
are,  I  have  not  had  any  letter  of  yours  since  March  23,  I 
think. 

To  Col.  McCarrison,  in  Alexandria 

Amarah,  May  25.  I  have  had  a  very  interesting  time  in 
acquiring  new  experiences,  e.g.  the  smell  of  cholera,  etc.  etc., 
but  of  course  terribly  depressing  ones.  I  am  pleased  with 
our  new  D.M.S.,  Treheme,  he  is  certainly  a  movie.  Of  course 
the  evils  arc  so  incredible  that  it  takes  a  man  some  time 
actually'  to  realise  what  is  going  on  :  and  until  you  have 
realised  it  to  the  full  you  cannot  suggest  remedies.  This 
campaign  will  like  the  rest  of  the  War  gradually  pull  out  as 
we  require  :  but  I  see  no  chance  of  getting  to  India  for  my 
round,  before  going  home,  under  less  than  a  year.  ...  I  can 
quite  sec  that  the  I. M.S.  as  a  service  is  temporarily  played 
out.  I  say  temporarily,  because  if  it  were  completely  re- 
organised it  could  be  made  a  fine  thing,  but  you  would  be 


MESOPOTAMIA  327 

grey  before  that  occurred,  not  to  say  a  white-haired  cherub, 
if  such  things  can  be.  I  left  Shaik  Saad  with  great  regret, 
as  Sweet  and  all  the  other  people  were  so  very  pleasant,  and 
moreover  there  was  a  chance  of  getting  constructive  reforms 
carried  out.  ...  Of  course  it  is  intensely  hot  here  :  prickly 
heat,  etc.,  all  the  go.  Food  here  at  Amarali, '  fair  to  middling ' : 
was  very  short.     Quarters  now  comfortable  in  a  house. 

To  Lady  Horsley 

Amarah,  May  26.  We  have  had  a  grand  reUef  here — 
the  blowing  of  the  North  wind.  It  has  made  lovely  cool- 
nesses at  times,  and  one  is  dried  so  quickly  that  the  dis- 
comfort of  the  liquid  layer  is  gone.  So  also  have  most  of 
the  insect  world.  This  afternoon  I  had  to  go  to  the  cholera 
camp  here,  and  afterwards  walked  along  a  ^villow-bordered 
branch  of  the  Tigris  by  which  fig-trees  and  a  few  vines  are 
cultivated  more  or  less,  chiefly  less.  It  was  a  lovely  evening, 
and  the  black  and  white  kingfishers  were  having  a  great  time 

on  a  shoal.  ...  I  have  just  heard  to-day  that  had 

actually  had  the  hardihood  to  refuse  the  Y.M.C.A.  offer 
of  canteens  on  the  ground  (among  others)  that  they  would 

not  sell  whisky  to  the  officers.  .  .  .  visited  recently  a 

Brigade  which  has  been  reduced  to  a  shadow,  in  which  he 
thanked  them  for  their  fighting  and  hardships,  and  said  he 
was  doing  his  best  to  reward  them  by  getting  up  beer  I 
The  men  are  furious  at  this  insult,  and  say  they  came  to 
fight  for  the  Empire  and  not  for  half  a  pint  of  beer.  I  suppose 
he  is  just  one  of  the  alcoholics  with  which  our  Staff  is  planted 
thickly,  and  poor  wretched  man  tliought  he  was  giving 
pleasure  by  his  wretched  jape.  Considering  the  intense 
sufferings  of  these  men  it  was 
beyond  endurance  to  be  promised 
a  glass  of  beer.  .  .  . 

Amarah,  May  30.  .  .  .  I  am 
perfectly  fit.  Of  course  it  's  no 
end  hot,  but  that  doesn't  worry 
me  like  the  work,  which  is  endless 
and  excessively  difficult.  As  regards 
the  heat,  the  sparrows  sit  like 
this,  and  the  fowls  not  only  do  the 
same  but  stand  in  a  draught 
(when  that  can  be  found)  holding 
their  wings  out  so  as  not  to  warm  their  bodice.  Fortu- 
nately, wljcn  it  lias  mounted  up  day  after  day  and  you  think 
it  's  going  to  bust  the  tluTuiomctcT,  the  N.  wind  blows  up, 
as  to-day  for  instance,  and  then  although  it  's  a  hot  blast 
it  acts  like  the  fans  which  the  liars  in  tlu'  House  of  Commons 
said  the  poor  chaps  in  the  hospitals  had  got,  and  at  any  rate 


p8  SIR  VICTOR  HORSLEY 

you  are  dry,  which  for  work  and  especially  writing  is  a  great 
comfort. 

I  enclose 's  kind  notliingnesses  in  answer  to  my  request 

that  if  he  heard  of  anything,  would  he  communicate  to  you. 
If  you  get  the  opportunity,  it  would  be  just  as  well  to  ask 
him  to  find  out  if  the  Liberal  party  intend  to  oppose  me  as 
they  are  doing  all  the  time,  as  then  my  course  would  at  least 
be  clear.  I  note  liis  statement  with  satisfaction,  that  no 
constituencies  are  being  nursed,  because  that  at  any  rate 
would  mean  a  much  fairer  show  when  the  General  Election 
does  come.     It  would  be  a  better  run  for  it  at  any  rate. 

Now  about  the  U.D.C.  Of  course  I  quite  agree,  and  as 
regards  Ponsonby's  attack  on  Morgan  I  have  written  a 
quiet  protest  pointing  out  that  all  Morgan  has  done  is  to 
publish  evidence  of  the  results  to  be  obtained  from  mili- 
tarism and  conscription  :  that  the  German  atrocities  he 
never  claimed  to  be  not  due  to  militarism  :  and  that  since 
the  Kriegsbuch  was  publislied  in  a  time  of  peace  without  the 
slightest  objection  from  the  German  people,  it  was  obvious 
that  they  were  suffering  from  a  certain  degree  of  moral 
decadence  :  and  that  Germany  was  the  only  nation  which 
had  pubUshed  such  instructions  to  its  officers.  As  to  Morel, 
of  course  it  is  unpardonable  :  and  Dr.  Sj-nge's  letter  (which 
had  already  appeared  in  War  and  Peace,  and  I  think  the 
Common  Cause  as  well)  is  quite  knocked  out  by  the  Witten- 
berg report.  Wittenberg  was  one  of  the  camps  she  visited 
after  it  had  been  cleaned  up  :  and  she  does  not,  I  think, 
allude  to  the  horrors  at  all. 

A  Sikh  has  just  brougiit  in  your  most  welcome  wire  to 
say  you  have  got  home  all  right.  That  is  very  great :  and 
I  suppose  the  floodgates  of  speech  are  now  open  wide.  It 
must  feel  very  pleasant  to  be  home  again,  and  I  am  now 
perfectly  thankful,  especially  as  the  two  boys  will  both  be 
there  to  meet  you.  I  can  quite  imagine  it,  and  it  is  a  delight- 
ful dream.  My  love  and  respects  to  them  all.  ...  I  think 
I  will  turn  in  now,  the  hurricane  lamp  is  an  abominably 
bad  light  and  collects  all  the  beetles  round  for  miles.  If 
you  don't  look  out  they  get  into  bed  with  you  and  mak«  it 
gritty.  Love  to  all  the  party.  How  glad  they  must  be  to 
see  you. 

Amarah,  June  5.  I  have  had  a  splendid  mail  this  week, 
quite  a  shower  of  letters,  so  am  naturally  very  bucked, 
because  I  now  know  wliat  is  going  on  with  each  and  all.  I 
find  that  is  the  real  trouble  of  being  away.  .  .  .  Now  for 
details,  'orribil  dcctoils.  This  upside-down  sort  of  place  is 
going  it  strong  in  the  way  of  a  hot  boisterous  wind  and 
burning  sun.  If  you  get  well  in  the  wind's  eye,  you  are 
pleasantly  cooled,  because  it  dries  you  up  far  quicker  than 


MESOPOTAMIA  329 

the  sun  can  make  you  perspire,  so  you  keep  moving  .*.  cool- 
ing .•.  smiling.  As  to  '  our '  health,  we  are  quite  well  and 
robust.     As  to  '  our '  servant,  he  is  the  very  idlest  scoundrel 

1  have  met,  who  having  evidently  served  some  globe- 
trotters reedises  he  cannot  do  me.  He  serves  some  pur- 
poses, develops  extraordinary  maladies,  which  is  common 
among  these  followers  here,  because  they  live  like  pigs, 
batlie  in  the  muddy  water  and  drink  it  at  the  same  time, 
and  you  can't  stop  them  because  they  having  no  educa- 
tion whatever  are  per  conseq.  pigheaded.  Now  the  other 
servant  we  got,  and  who  died  of  the  cholera  in  our  camp  at 
24  F.A.  the  Front,  was  a  substantial  sort  of  person  ;  and 
we  are  left  with  this  Uttle  villain.  A  few  days  ago  he  swelled 
all  over,  much  to  '  our  '  annoyance  :  it  all  went  down  with 
iron  and  arsenic,  and  he  probably  is  an  opium-eater.  Fortu- 
nately I  see  to  evcrj'thing  myself :  and  so  he  has  his  uses, 
base  though  they  are.  As  to  '  our  '  food,  it  may  be  '  whole- 
some, but  it  (certamly)  is  not  good.'  The  ration  bread  is 
excellent  :  we  have  now  got  plenty  of  jam  :  the  flies  won't 
go  near  the  butter,  which  is  eatable — very  odd  they  don't 
like  it,  but  they  won't  look  at  it — which  is  very  fortunate  : 
good  eggs :  quaker  oats  (you  would  laugh  to  see  me  eating 
porridge  per  force,  though  I  am  gradually  getting  to  partly 
like  it)  :  once  in  a  blue  moon  cornflour  and  tinned  plums. 
.  .  .  The  mess  here  are  very  agreeal)lc  fellows,  mostly  Irish 
and  quite  amusing :  we  occasionally  go  out  in  a  bcUum  to 
go  do\vn  and  walk  into  the  mudflats  and  see  the  crops ! 
Yesterday  went  for  a  walk  up  the  river  bank  among  the  palm- 
trees,  etc.,  and  came  to  a  shrine-mosque  which  the  Hindoo 
sepoys  had  defiled.  It  was  I  suppose  out  of  revenge  for 
the  sniping  and  robbery  which  still  goes  on  because,  chiefly, 
our  people  are  distinctly  slack  in  arranging  the  camp  defences. 
Night  before  last  I  was  dining  with  the  mess  of  the  12th 
Indian  Hospital  :  their  mess  is  a  mosquito-net  room  on  the 
river  bank  under  the  palm-trees,  and  very  pleasant  indeed  : 
with  the  coffee  arrived  a  shot,  and  then  on  each  bank  the 
sentries  began  potting  steatlily.  It's  all  right  as  long  as 
they  fire  outwards,  but  they  don't  always.     Tlicrc  had  been 

2  Arabs  tried  the  day  before,  and  will  be  hung  to-day  : 
so  I  daresay  they  were  trying  to  get  some  of  their  own  back. 
Then  the  jackals  started  their  Promenade  Concert :  but  they 
never  keep  it  up  for  more  than  ten  minutes,  so  it  's  small 
and  early  with  them.  By  the  aforesaid  shrine,  I  heard  a 
black  partridge  (really  a  francolin)  so  tracked  him  and  tiicn 
put  him  up  :  it  Wiis  very  fine,  as  he  got  up  with  the  hen, 
only  a  few  yards  away.  ...  I  am  sending  you  19  i)rints, 
to  show  you  the  country,  the  water-supply,  and  conveyance 
of  the  sick  and  wounded. 


330 


SIR  VICTOR  HORSLEY 


To  his  Daughter 


The  forward  rako  of  the  boats'  masts  is  tiot  bad  drawing :  it  is  their 
picturesque  rule.  Also  colour  in  your  mind's  eye  the  cap  of  the  minaret  with 
beautiful  l)lup  enamel,  and  here  and  there  yellow.  The  insects,  thouRh  the 
largest  of  their  kind,  I  have  been  obliged  to  omit  as  out  of  proportion  to 
the  boats. 


Amarah,  June  8,  .  .  .  This  here  tovNTi  of  Amarah  seen 
from  the  bridge  of  boats  (Turkish)  makes  quite  good  attempts 
to  be  picturesque  :  the  ladies  in  the  foreground  are  paddling 
a  farm-boat,  which  brings  up  vegetables  and  fuel,  brush- 
wood and  dried  cowdung.  There  are  mud  fortified  farm- 
steads all  along  the  banks.  Not  a  few  have  palm-groves 
J  mile  long,  with  figs,  limes,  etc.,  under,  so  that  they  really 
form  very  pleasant  but  exceedingly  rough  walks,  for  the 
original  deep-ploughed  furrows  are  left  and  covered  with 
grass  and  weeds  a  foot  or  two  high.  Of  course  they  make 
wonderful  jackal  covers,  and  the  demoniacal  row  those 
ladies  and  gentlemen  made  last  night  was  worthy  of  a  gramo- 
phone close  where  you  didn't  want  it.  Inside  the  walls, 
which  are  only  about  2  feet  thick  but  wondrously  hard, 
they  have  malting  huts,  ovens,  cooking  places,  and  a  sakkya 
of  modem  construction,  made  in  England  as  a  rule,  for 
distributing  water  to  the  faiTnstead  and  farm  generally. 

The  children  are  most  amusing  here,  always  fooling.  The 
adults  here,  though  frequently  getting  wet  of  course,  always 
try  to  tuck  their  skirts  up,  and  squat  to  wash  their  hands. 
I  saw  a  person  aged  four  imitating  her  betters,  when  a  com- 
panion pulled  the  back  of  her  tucked-up  nitey,  with  fatal 
results.  They  both  roared  with  laughter,  and  rolled  about 
in  the  muddy  water  like  pra\\Tis.  Boys  will  be  boys,  and 
those  of  Aniarali  act  up  to  this  great  principle  most  com- 
pletely. 

The  Bazaar  here  is  quite  good,  because  it  is  a  dark  lofty 
tunnel  of  Arab  houses.  At  the  entrance  is  an  interesting 
caf^,  quite  a  Teniers  interior  :  I  may  get  a  photo  of  it,  but 
have  no  films  to  spare  till  I  get  some  from  Bombay  :  the 
fircj)lace  for  boiling  the  coffee  has  a  wonderful  fluted  hood 
over  the  charcoal,  some  H  feet  high.     All  the  coffee-pots  here 


MESOPOTAMIA  :^3i 

are  Persian,  with  enormous  spouts  like  a  toucan's  beak  : 
and  they  also  sell  Rose's  lime-juice  with  sugar  and  water. 
This  is  a  popular  drink.  Considering  the  Army  demand 
too,  Mr.  Rose  must  '  be  doing  well  as  any  lunatic  can  tell.' 
Our  company  here  has  been  increased  by  a  lady  of  very 
mature  age  named  Dugga.  She  has  taken  a  fancy  to  sleep 
under  my  table,  and  is  always  ready  for  ftwre  water.  She 
is  a  fairly  well-bred  Persian  greyhound,  quite  an  acquisition, 
black.  .  .  .  Well,  I  must  adopt  the  gentle  shout  of  the 
undergrads  at  the  Cambridge  Suffrage  meeting,  '  plea- 
SESHUTUP.'    Farewell. 

To  Lady  Horsley 

Amarah,  June  12.  ...  I  find  I  am  being  of  considerable 
use.  I  get  letters  and  visits  (numerous)  from  people  I  never 
heard  of,  recounting  changes  on  the  lines  I  laid  down  as 
principles  in  Simla.  I  really  do  not  think  that  it  ever 
occurred  to  the  Ind.  Govt,  to  deal  with  the  Army  and  Medical 
Services  on  principles  at  all.  Only  expediency.  It  is  very 
curious,  and  a  wonderful  study  of  constitutional  govern- 
ment. I  am  extremely  anxious  this  vile  rot  should  cease, 
so  that  I  may  get  to  India  to  see  more  on  the  spot.  This 
peripheral  business,  however,  is  of  course  the  finest  test, 
because  it  shows  how  absolutely  helpless  the  expedientist 
is  when  he  has  to  direct  things  which  are  out  of  his  immediate 
(short)  sight.     We  had  yesterday  arrive  just  on  a  flying  visit 

the  officer  sent  out  from  England  to  replace at  Simla. 

He  lunched  here  on  his  way  through.  Two  or  three  colonels 
were  here  too,  and  he  rather  put  me  in  a  '  difhculty  '  with 
the  rest  by  insisting  on  speaking  privately  to  me  for  20 
minutes  in  my  room.  He  really  wanted  to  know  what  I 
tiiought  of  the  whole  condition  of  things  medically,  and 
what  wanted  doing.  He  had  got  hold  entirely  of  the  right 
end,  namely,  the  outrageous  state  or  rather  absence  of 
necessary  transport,  and  in  fact  seemed  to  me  a  '  very  intel- 
ligent fellow  Bob.'  .  .  . 

We  are  all  very  fit  here,  those  who  are  teetotallers.  The 
weather,  as  the  General  says  in  Our  Boys,  '  It  is  hot ' :  and 
the  funny  thing  is  that  everything  feels  hotter  than  you 
expect,  because  of  course  it  is  about  110°.  For  instance  if 
I  want  to  look  inside  a  book  and  open  it,  the  inside  pages 
feel  hot  and  make  you  nearly  jump.  Of  course  in  the  sun 
it  is  150°  and  over  :  and  if  you  inadvertently  touch  iron 
you  do  jump,  and  probably  two  or  three  times,  '  not  once 
and  again,  but  again  and  again  and  again.'  Of  course  the 
evenings  are  charming,  though  now  wann  :  tiie  nuK)nlight 
on  the  river  and  the  sunset  lights  over  the  palm-groves 
when  wc  sit  down  to  dinner  on  the  mud  roof  aie  very  charm- 


332  SIR  VICTOR  HORSLEY 

ing.  When  the  insects  (which  vary)  are  in  full  blast,  and 
we  are  bombarded  by  locusts  and  beetles,  there  comes  over 
our  heads  a  good-sized  night-jar,  like  an  express  train,  who 
dines  above  us  if  not  exactly  with  us. 

Amarah,  June  19.  I  am  going  up  to  the  front  again 
to-morrow  to  complete  the  surgical  equipment.  The  incredible 
slowness  with  which  things  move  here  is  very  difficult  to 
put  into  words.  The  convoy  of  the  sick  and  wounded  is 
siill,  as  I  wired  to  Simla,  '  grossly  insanitary  and  inhuman.' 
(Cock  sparrow  hard  at  work  tearing  up 
my  matting  in  this  room  to  get  lining 
for  his  nest.)  What  is  so  infernal  is  that 
this  is  an  Indian  Govt.  show.  Now  in 
India  soda-water  is  every  one's  per- 
quisite, as  it  were.  It  is  as  common  cis 
ordinary  water.  Out  here  the  convoys 
of  sick,  with  a  temperature  of  I20°-I37°  under  the  awnings, 
have  3  or  4  doz.  sodas  for  315  sick  and  convalescents. 
The  answer  is,  '  Oh,  there  are  no  more  bottles ' :  these 
scoundrels  in  India  never  taking  the  sHghtest  trouble  during 
these  20  months  to  provide  bottles  and  machines.  But 
there  you  are :  this  (in  the  face  too  of  provision  of 
whiskies  and  sodas  for  the  staff)  is  but  one  of  the  looi 
scandals  of  this  campaign.  My  business  now  is  of  course 
to  see  that  the  surgical  ship  is  in  full  swing,  and  to 
arrange  for  two  sisters  to  come  up.  .  .  . 

One  of  the  Augean  Stables  that  I  found  in  full  swing  and 
General  Treheme  was  scandalised  with,  and  supplied  the 
administrative  power  I  do  not  possess,  was  the  so-called 
Convalescent  Depot.  Photo  i  is  this  filthy  hole  into  which 
no  less  than  1424  men  were  put  convalescent.  It  was  really 
an  old  granary  used  as  a  stable  by  a  mountain  battery.  They 
cleared  out  the  battery,  scraped  the  ground  a  little,  and  the 
same  afternoon  put  in  convalescents,  etc.  It  was  exactly 
like  the  drawings  we  had  of  1S15  of  Napoleon  visiting  the 
Hospital  at  Jaffa.  The  men  were  actually  of  course  living 
on  this  horrible  mud  floor,  and  had  their  food-tins  on  it, 
etc.  Next  to  it,  though  separated  by  a  narrow  roadway, 
was  a  huge  compound  (photos  2  and  3)  full  of  sick  iiorses 
and  remounts.  When  I  was  there  the  mud  and  filtii  was 
partly  drying  up  :  see  a  mass  in  the  foreground  of  3,  in 
front  of  the  Arab  sayces.  The  smell  was  obvious  :  but  I 
was  told  by  the  M.O.  in  charge  that  for  2  months  it  had 
been  awful,  and  no  remonstrances  could  get  rid  of  the  horses, 
though  the  convalescents  were  made  sick  by  it. 

.  .  .  Give  my  best  respects  all  round.  Send  me  out 
20  Alcohol  and  Human  i3odj' :  I  can  easily  get  rid  of 
them.  They  have  frankly  told  me  here  that  the  different 
messes  were  panic-stricken  by  my  advent  :   thought  I  should 


MESOPOTAMIA 


333 


get  up  and  physically  and  morally  denounce  them,  and  as 
they  knew  they  had  no  excuse  for  their  whisky  drinking 
they  were  proportionately  uncomfortable.  Now  they  all 
want  me  to  stop,  although  I  have  denounced  them  over  and 
over  again.     PS. — Moreover  they  are  drinking  less. 

On  board  T2,  going  to  Front,  June  22.  T2  is  a  large  sort 
of  passenger  tug  ;  and  lashed  alongside  are  two  mahelas 
and  their  Arab  and  Sidi  boys  (descendants  of  slaves,  Africans 
of  course)  crews.  The  prow  of  the  port  one  is  quite  pleasant, 
as  well  as  the  furnishings  of  the  forecastle.  The  prow  is 
quite  a  work.     It  is  carved  ad  lib.  with  geometrical  designs  : 


on  the  top  is  a  bronze  corroded  Turkish  crescent  and  star  : 
nailed  to  the  middle  of  the  star  by  a  big  bolt  is  an  absurd 
bird,  sort  of  Caran  d'Ache,  really  to  serve  as  a  belaying-pin, 
which  the  head  and  tail  admirably  fulhl.  The  yard  like  all 
Arab  yards,  a  wonderful  compound  of  odds  and  ends.  The 
coiled  hawser  behind  the  prow,  completed  by  a  blanket, 
makes  a  hut  under  which  two  hens  pass  a  happy  day,  especially 
after  they  have  been  lowered  into  the  river  to  cool.  Hy  the 
side  is  a  calabash  tobacco-pipe,  sort  of  '  ship's  tocjthbrush  '  ; 
any  one  who  has  tobacco  to  put  in  the  funni'l  end  is  entitled 
to  suck  at  the  other.  The  mud  oven  is  about  3  feet  high 
and  a  foot  wide  at  the  top.  In  the  evening  it  is  very  pretty, 
as  they  heat  it  by  wood  and  the  llames  come  gaily  out  at 
the  top,  to  the  imminent  destruction  of  the  whole  fleet  : 
but  barring  Kamcses  in.  I  haven't  secnjja  ship  on  fire,  though 


334 


SIR  VICTOR  HORSLEY 


they  are  laden  with  compressed  chaff,  matting,  etc.  etc., 
and  of  course  no  one  lias  any  lire  appliances.  The  crew  all 
have  coffee  in  the  afternoon,  or  tea.  The  tea-things  and 
little  coffee  cups  and  spoons  are  all  solemnly  packed  away 
again  in  a  little  square  box  with  compartments  and  orna- 
mented with  strips  of  perforated  and  bordered  steel.  They 
eat  their  chupatties  baked  in  the  oven  dipped  in  the  tea, 
and  spread  wonderful  carpets  and  thick  padded  rezais,  sort 
of  mattress  quilt,  to  sleep  on.  The  poor  old  mahelas  leak 
somewhat,  and  day  and  night  at  intervals  have  to  be  bailed 
out  in  pailfuls,  as  of  course  they  won't  run  to  a  pump ; 
although  such  is  the  cost  of  wood,  the  expense  of  building 
a  mahela  is  about  £800. 


To  his  Daughter 

112th  Indian  Field  Ambulance,  Filayich,  July  i.  .  .  .  We 
have  got  Mr.  Nebuchadnezzar's  furnace  heated  '  seven  times 
hotter  than  before.'  The  N.  wind  really  is  bucking  up, 
but  as  it  blows  over  several  hundred  miles  of  mud  flat, 
etc.,  it  is  no  longer  a  mountain  breeze  from  glaciers,  but 
something  quite  the  reverse.  However,  it  moves  the  air, 
and  that  is  distinctly  worth  having,  even  though  of  course 
there  is  dust  everywhere.  We  sleep  usually  for  half  an 
hour  before  lunch  and  an  hour  after,  so  '  contemplation '  is 
easy  as  an  excuse.  All  the  insects  go  to  sleep  too  at  the 
same  time  :    except  the  house-flies,  of  whom  a  hardy  half- 


dozen  survive  chiefly  to  annoy  us  if  sleeping.  However, 
thank  goodness,  we  keep  one  or  two  tarantula  spiders,  like 
this  person,  who  live  up  at  the  top  of  the  tent-poles  and  dash 


MESOPOTAMIA 


335 


round  like  Bedouins  and  mop  up  the  flies  which  always 
towards  evening  tend  to  roost  on  the  roof-canvas.  Talking 
of  insects,  I  was  writing  a  Report  outside  the  tent  last  night, 
when  a  passing  acquaintance  hurried  by,  chinchilla-grey 
bonnet  and  terracotta  and  black  shawl.     He  or  she  explored 


various  plants,  and  then  selected  a  bare  stalk,  not  really 
up  to  weight,  but  that  did  not  stop  him  climbing  nimbly 
to  the  top  and  beginning  to  eat  the  said  stalk  from  the 
top  downward.  He  ate  the  whole  tiling,  descending  all 
the  time,  and  even  finished  the  stump  in  the  ground. 
He  reminded  me  of  the  drunken  rioter  in  Hogarth's  picture 
sawing  off  the  signboard.  .  .  .  We  also  have  a  very 
tame  sort  of  wagtail,  grey  body  and 
wings  and  dark  red  tail,  which  drinks 
at  our  coolers — Persian  water  pots, 
porous,  which  leak  slowly  into 
saucers.  The  only  other  birds  are 
the  sand-grouse  and  bee-eater.  It 
is  rather  a  land  of  surprises.  The 
ground  is  covered  with  a  melancholy- 
looking  grey  scrub,  bushes  about  a 

foot  high,  and  here  and  there  some  rather  larger  ones.  These 
yestcrclav  morning  were  covered  witli  flowers  exactly  like 
Christmas  roses  :  quite  pretty,  and  much  appreciated  because 
unexpected. 

All  the  grey  scrub  makes  it  very  difficult  to  spot  things  at 
a  distance,  and  the  mirage  renders  it  absohitely  impossible 
about  3  miles  off.  Consequently  our  guns  are  rather 
outed,  and  carry  on  a  kind  of  morning  and  evening  hate. 
The  shell-bursts  in  this  funny  soil  give  all  sorts  of  shaj^cs : 
I  wanted  to  photo  them  tlirougli  a  loophole  ;  but  tiio  Turks 
arc  very  handy  with  their  machine-guns  on  our  loopholes  : 
and  no  one  is  allowed  to  open  them  up,  except  when  there 
is  a  strafing  going  on.  .  .  .  The  Turkish  aeroplanes  being 
twice  as  fast  as  ours  do  what  they  like  ;  and  droj^j^cd  a  note 
expressing  the  hope  tliat  if  (as  hajipened  on  this  side)  they 
had  to  evacuate  llicir  trenclics,  they  hoped  we  would  not 
claim  we  had  '  carried  them.'     A  nasty  bit  of  sarcasm  richly 


336  SIR  VICTOR  HORSLEY 

deserved  by  us.  ...  I  hope  all  our  young  friends  are  doing 
well,  especially  my  two  sons  I     Farewell. 

To  Lady  Horsley 

112th  Indian  Field  Ambulance,  Front,  July  5.  It  is  now 
quite  obvious  that  nothing  can  or  will  be  done  here  till 
October.  I  am  therefore  arranging  to  go  back  to  India 
and  do  some  of  the  inspecting  work  I  have  got  to  do  at  the 
end  of  this  business,  and  return  here  in  say  September  (end). 
My  plan  is  to  go  from  here  down  to  Shaik  Saad,  stop  there 
a  couple  of  days  ;  go  on  to  Amarah,  stop  there  two  days 
and  pick  up  my  rest  of  Idt.  At  Basrah  I  shall  probably 
be  kept  a  week  for  a  boat,  and  in  any  case  shall  have  to 
hold  no  end  of  pow-wows  with  people  who  do  not  neces- 
sarily understand,  even  when  you  have  got  them  face  to 
face.  Treheme's  plans  here  are  really  destroyed,  the  only 
thing  that  is  surviving  and  clearly  must  survive  is  my  surgical 
hospital  ship,  P8.  They  are  fixing  it  to  the  left  bank,  which 
I  asked  for  as  the  non-dusty  one,  but  which  I  was  assured 
was  impossible.  It  is  really  almost  absurd  for  any  unit 
to  make  any  arrangement :  it  is  certain  to  be  upset :  and 
probably,  once  in  a  new  place,  will  i)e  sent  back  to  its  old 
one  ;  which  has  just  happened  to  the  only  clearing  station 
we  had  here,  tliough  Treheme's  plan  involved  four  such 
stations  being  planted  here.  Of  course  this  sort  of  thing 
is  inevitable  in  a  hand-to-mouth  arrangement  bom  of  non- 
preparation.  I  only  hope  that  the  Mesopotamian  Enquiry, 
when  it  comes  off,  will  have  sufficient  sense  to  understand 
all  these  causes  of  failure.  As  regards  my  programme.  It 
is  quite  plain  that  I  have  to  make  a  localised  tour  from 
Bombay  to  inspect  stations — Poona,  Nagpur.  Now  I  think 
I  can  get  all  that  done  during  August  and  September  :  so  as 
to  enable  me  to  make  a  straight  run  round — Karachi,  Lahore, 
Lucknow,  Calcutta,  Hyderabad,  Madras,  Ontacamund, 
Ceylon — when  all  this  infernal  stupidity  is  over. 

I  must  be  off  now  to  see  the  D.D.M.S.,  to  try  and  find  out 
whether  I  can  get  down  to-morrow  night  to  Shaik  Saad. 
There  is  nothing  going  on,  except  the  evening  aeroplane 
comes  over  and  bombs  us  as  he  likes,  because  we  have  nothing 
to  do  him  with.  '  This  is  War.'  Blooming  health,  in  spite 
of  continuous  1 10-120  in  shade. 

On  July  14,  Colonel  Fell  visited  him  in  Amarah,  and  had 
tea  with  him.  On  that  day,  he  said  that  he  was  not  feeling 
very  well  :  but  he  was  still  at  work.  '  I  was  talking  to  him,' 
one  of  his  friends  writes,  '  two  days  before  he  died.     He  was 


MESOPOTAMIA  337 

full  of  the  bad  conditions  everywhere,  and  of  the  improve- 
ments that  should  be  made.  He  then  told  us  that  any 
influence  he  might  possess  would  be  used  to  the  utmost  to 
get  all  medical  arrangements  put  on  a  better  footing.  He 
was  very  thorough  in  everything  he  did,  not  sparing  himself 
in  the  shghtest,  and  often  working  throughout  the  hottest 
part  of  the  day,  when  most  men  (much  younger  men  too) 
were  resting.  When  he  went  down  from  the  front,  he  took 
with  him  all  the  evidence  he  could  collect — such  as  specimens 
of  Ume-juice  issued  to  the  troops,  etc. — all  carefully  labelled, 
dated,  and  tabulated,  ready  for  when  he  drew  up  his  report.' 
His  notes  on  these  matters  have  not  reached  his  home. 

On  the  15th,  his  temperature  w^as  103°  ;  and  so  soon  as 
the  hottest  time  of  the  day  was  over,  he  was  moved  into 
No.  2  British  Gk^neral  Hospital.  Captain  T.  M.  Body, 
R.A.M.C,  who  had  been  admitted  to  it  two  days  before, 
writes  : 

There  is  no  one  for  whom  I  ever  had  a  greater  respect. 
He  came  to  Mesopotamia  as  a  Consulting  Surgeon,  but  at 
a  time  when  there  was  practically  no  surgery  ;  so  he  in  con- 
sequence had  to  take  rather  a  wide  view  of  his  work  ;  and 
I  think  decidedly  that  there  was  no  one  who  could  have 
done  that  work  with  more  enthusiasm — and  what  is  more 
important,  such  good  results.  His  enthusiasms  were  bound- 
less ;  and  in  a  country  which  is  not  noted  for  energy,  this 
characteristic  was  invaluable,  as  not  even  the  most  slothful 
of  us  could  sit  down  and  see  a  man  nearly  60  years  of  age 
doing  more  than  us,  some  twenty  or  more  years  younger. 
Like  all  good  sociahsts,  he  was  an  absolute  autocrat,  conse- 
quently he  got  things  done,  often  much  to  the  disgust  of 
the  regular  officials  at  the  irregularity  of  the  method.  He 
argued  that  if  things  were  necessary  for  the  health  of  the 
men,  and  these  things  could  not  be  got  through  the  ordinary 
channels,  then  we  must  find  other  means.  But  when  I 
proceeded  to  tell  him  of  the  few  things  I  had  stolen  for  my 
operating-theatre,  he  thought  that  I  should  iiave  had  re- 
course to  otiier  means.  Wc  lost  a  man,  fearless  and  honest, 
who  was  doing  something,  and  would  have  done  more.  As  a 
member  of  the  medical  profession  I  feel  this  more,  as  he  was 
one  of  the  very  few  medical  men  who  had  the  car  of  the 
public — (you  who  hve  in  London  must  shed  your  provin- 
cialism before  you  can  appreciate  this) — and  would  have  used 
his  voice  to  improve  and  help  our  profession,  and  help  it 
at  a  time  when  wc  want  so  much  help.  .  .  . 

Y 


338  SIR  VICTOR  HORSLEY 

On  Saturday,  July  15,  about  5  p.m.,  I  saw  Victor  Horsley 
carried  into  the  Hospital  in  a  carr^-ing-chair,  sitting  up,  look- 
ing fairly  vveU.  The  impression  left  on  my  mind  was  that  he 
considered  that  he  was  being  made  rather  an  unnecessary  fuss 
of.  His  temperature  on  admission  was  about  103°,  and  rose 
the  same  evening  to  105°  or  higher.  His  medical  officer  was 
Barwell,  a  University  College  man,  who  was  on  the  junior 
staff  in  Victor  Horsley 's  time  ;  a  thoroughly  good  physician  ; 
and  everything  was  done  that  human  skill  and  ingenuity, 
and  the  means  at  disposal,  allowed  :  all  the  available  ice, 
which  I  am  afraid  was  not  much,  was  used  :  but  in  spite 
of  it  all,  the  temperature  remained  high. 

The  Hospital  was  on  the  left  bank  of  the  river  :  a  good 
stone  building,  originally  a  Sheikh's  palace.  In  1915,  it 
was  captured  and  held  very  gallantly  by  the  Norfolks  :  a 
mere  handful  of  men  held  it  for  several  days,  before  rein- 
forcements could  arrive  up  the  river  :  from  this  exploit,  it 
had  got  the  name  of  Norfolk  House.  Major  Mackworth, 
I.M.S.,  who  hkewise  was  a  patient  in  the  Hospital,  writes  : 

The  first  time  we  met  was  when  he  visited  our  Indian 
General  Hospital.  Lt.-Col.  Anderson,  the  O.C.  of  the 
Hospital,  introduced  him.  I  failed  to  catch  the  name  of 
the  colonel  wearing  red  tabs  ;  and  took  him  to  be  some 
inspecting  combatant  officer.  Just  then  the  O.C,  being 
called  away,  asked  me  to  do  the  honours  and  show  the  officer 
round.  We  entered  the  operating-theatre.  I  showed  him 
the  wonders  therein  :  an  artery  forceps — '  an  instrument 
for  pinching  blood-vessels  when  they  arc  cut  ' — along  with 
some  other  instruments  in  daily  use.  I  still  remember  that 
amused  smile,  and  his  remarks — '  How  marvellous  ' — '  How 
very  interesting.'  We  proceeded  to  the  wards.  I  shudder 
to  think  of  the  offhand  way  I  demonstrated  15  trephine- 
cases  under  my  charge.  It  was  not  till  afterwards  one 
reahsed  his  identity,  and  what  an  enormous  faux  pas  had 
been  perpetrated.  He  visited  our  hospital  on  the  next  day, 
whereupon  I  apologised  for  not  having  recognised  who  he 
was.  '  That  's  all  right,'  says  he  :  '  you  must  excuse  me 
my  little  joke.'  After  that  wc  became  very  friendly  ;  he 
was  a  frequent  visitor,  and  one  benefited  much  from  his 
useful  advice. 

On  my  remonstrating  with  him  for  going  out  in  the  heat 
of  the  day  on  one  occasion  (3  p.m.  June,  Mesopotamia  is 
decidedly  warm)  with  only  a  puggri,  cloth  coat  on,  and  no 
spinal  pad,  his  rejoinder  was,  '  Are  you  a  teetotaller  ?  ' 
Sad  to  say,  shortly  after  this  we  were  patients  together  in 


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MESOPOTAMIA  339 

the  Hospital  where  he  died.  I  will  ever  remember  him  as 
one  of  the  most  kindly  and  courteous  gentlemen  I  have  ever 
met.  One  never  felt  the  slightest  restraint  in  discussing 
with  him  even  subjects  which  were  his  speciahty. 

Even  on  the  Saturday,  he  was  still  at  work.  There  is  a 
letter  in  the  British  Medical  Joumal,  September  2,  1916, 
from  Amarah  : 

I  have  just  been  to  the  Hospital  where  Sir  Victor  Horsley 
was  lying  ill ;  to  find  that  he  passed  away  a  few  minutes  ago. 
He  had  only  j  days  ago  returned  to  Amarah  from  the  front, 
and  seemed  to  be  in  his  usual  health  and  spirits.  Only 
yesterday,  Saturday  morning,  I  had  some  conversation  with 
him  on  a  subject  which  was  interesting  him,  the  provision 
of  hospitals  with  laboratories  :  and  he  then  set  out  to  walk 
back  to  his  camp,  which  was  about  a  mile  and  a  half  away 
across  the  Tigris  bridge  and  over  the  open  plain.  The 
shade  temperature  was  over  110°,  and  the  atmosphere  humid. 
When  he  got  to  his  tent,  he  heard  there  was  a  sick  officer 
he  knew,  about  half  a  mile  further  on  ;  he  went  on  to  see 
him,  and  examined  him  carefully.  He  complained  of  head- 
ache later  in  the  day,  and  was  admitted  to  the  Hospital  on 
Saturday  evening.  ...  I  can  speak  of  his  untiring  energy 
and  the  loyal  devotion  and  singleness  of  purpose  shown  in 
his  every  action  up  to  but  a  few  hours  ago.  Those  who  have 
met  him  recently  are  aware  that  he  had  framed  a  very  severe 
indictment  against  those  he  beheved  were  responsible  for 
the  mismanagement  which  he  thought  characterised  some 
aspects  of  the  campaign.  It  is  only  three  days  since  he 
returned  from  the  front,  and  he  was  about  to  return  to  India 
for  a  spell  to  prepare  liis  report. 

Major  Grey  Turner  writes  : 

I  happened  to  come  across  him  just  as  he  was  about  to 
be  admitted  to  Hospital.  Though  he  was  looking  ill,  he 
was  as  cheerful  as  ever,  and  at  once  began  to  talk  about  some 
arrangements  of  mutual  interest.  He  told  me  that  up  to 
that  Saturday  he  had  been  absolutely  well,  and  that  he  had 
not  felt  the  heat  too  trying.  I  am  told  that  it  was  a  very 
usual  thing  to  see  him  in  Amarah  during  the  heat  of  the  day, 
and  there  are  many  who  thought  that  he  exposed  Iiimsclf 
too  much. 

On  Sunday,  July  16,  his  temperature  rose  to  107°:  he 
became  unconscious,  and  died  that  evening.  It  is  certain 
that  he  died  of  heat-stroke  ;  there  was  a  rumour  that  he  also 


340  SIR  VICTOR  HORSLEY 

had  paratyphoid  fever  :  but  the  blood-tests  gave  no  support 
to  this  belief. 

Mr.  Martin  Swa3nie,  in  his  book  '  Mesopotamia,'  describes 
the  funeral : 

Shortly  after  we  left  Amarah,  the  news  came  that  Sir  Victor 
Horsley  had  died.  It  was  in  a  season  of  extreme  heat,  when 
death  comes  suddenly  in  many  forms.  Eighty  officers  attended 
his  f  unercd.  He  had  a  coffin.  Wood  was  precious  in  Amarah. 
There  were  some  other  bodies  sewn  up  in  blankets.  A  long, 
dusty  march  of  a  mile  to  tlie  cemetery,  a  shallow  earth  grave, 
a  brief  ceremony,  the  same  for  all,  and  a  weary  tramp  home 
in  the  sun — that  was  the  final  picture.  There  is  one  more 
detail  to  add,  and  that  is  the  lovely  playing  of  the  '  Last 
Post  '  over  the  graves. 

Palms  were  laid  on  his  grave.  Later,  a  cross  of  white 
marble  was  placed  over  it.  He  had  gone  to  Mesopotamia 
knowing  that  he  might  die  there.  He  said  to  Lady  Horsley, 
just  before  he  left  Egypt,  '  Don't  worry  about  me  :  I 
don't  matter  :  I  can't  live  for  ever  :  it 's  the  young  that 
matter.' 


PUBLISHED    WRITINGS 

i88o.  Arrest  of  development  in  the  left  upper  limb,  in  association 
with  an  extremely  small  right  ascending  parietal  con- 
volution. By  H.  Charlton  I3astian  and  Victor  Horsley. 
Brain,  April  1880. 

1882.  On  '  Septic  Bacteria  '  and  their  Physiological  Relations. 
Appendix  to  nth  Annual  Report  of  Local  Government 
Board. 

1882.  On  the  existence  of  Bacteria,  or  their  Antecedents,  in 
Healthy  Tissues.  With  Dr.  F.  W.  Mott.  Joum. 
Phys.,  iii.  188. 

1882.  Articles  '  Bacilli '  and  '  Zjmfie '  in  Quain's  Dictionary  of 

Medicine. 

1883.  Note  on  the  Patellar  Knee-jerk.     Brain,  Oct.  1883. 

1883.  Four  cases  of  injury  to  the  brain  in  man,  illustrating  very 

exactly  the  position  of  the  cortical  motor  centres. 
Joum.  Phys.,  iv.,  supplement,  p.  5 ;  Proc.  Phys.  Soc, 
Dec.  13,  1883. 

1884.  Case  of  Occipital  Encephalocele  in  which  a  correct  diagnosis 

was  obtained  by  means  of  the  induced  current.  Brain, 
Pt.  xxvi.,  1884. 

1884.  On  the  existence  of  sensory  nerves  and  nerve-endings  in 
nerve-trunks,  true  '  nervi  nervorum.'  Proc.  Roy.  Med. 
Chir,  Soc,  n.s.,  i.  196.  See  also  Proc.  Physiol.  Soc, 
June  7,  1884. 

1884.  On  Substitution  as  a  means  of  restoring  Nerve  Function, 
considered  with  reference  to  Cerebral  Localisation. 
Lancet,  July  5,  1884. 

1884,  Consensual  movements  as  aids  in  diagnosis  of  disease  of 

the  Cortex  Cerebri.  Medical  Times  and  Gaz.,  Aug. 
16,  1884. 

1884-1890.  Annual  Roports  to  the  Committee  of  the  Brown 
Institution. 

1885.  The    Thyroid    Gland :    its   relation    to    the  pathology  of 

Myxccdcnia  and  Cretinism,  to  the  question  of  the 
surgirnl  trrntmont  of  Goitro,  and  to  ihr  General  Nutri- 
tion of  the  P>ody.     Brit.  Med.  Juurn.,  Jan.  17.  1885. 

Ml 


342  SIR  VICTOR  HORSLEY 

1885.  The  Motor  Centres  of  the  Brain,  and  the  Mechanism  of  the 
Will.     RoyiU  Institution  Lecture,  March  27,  1885. 

1885.  Acute  Septic  Peritonitis :  operation :  recovery.  Med.  Times 

and  Gaz.,  Sept.  26,  1885. 

1886.  Abstracts  of  Brown  Lectures  :   two  on  the  thyroid  glaud, 

three  on  epilepsy.     Lancet,  1886,  ii.  1163,  1211. 

1886.  Brain  Surgery.  Address  at  Brighton.  Brit.  Med.  Joum., 
Oct.  9.  1886. 

1886.  Epilepsy  produced  in  guinea-pigs.  Proc.  Med.  Soc.  Lond., 
1886,  X.  86. 

1886.  (t)  On  the  Relation  between  the  Posterior  Columns  of  the 
Spinal  Cord  and  the  Excito-Motor  Area  of  the  Cortex, 
with  especial  reference  to  Prof.  Schiff's  views  on  the 
subject.  (2)  A  further  and  final  criticism  of  Prof. 
Schiff's  experimental  demonstration  of  the  relation 
which  he  believes  to  exist  between  the  Posterior 
Columns  of  the  Spinal  Cord  and  the  Excitable  Area  of 
the  Cortex.     Brain,  April  and  October,  1886. 

1886.  Translation  of  Koch's  monograph, '  On  the  Investigation  of 
Pathogenic  Organisms  '  :  published  in  '  Recent  Essays 
by  various  authors  on  Bacteria  in  relation  to  disease.' 
Edited  by  W.  Watson  Cheyne.  London,  New  Syden- 
ham Society,  1886. 

1886.  On  an  apparently  peripheral  and  differential  action  of 
Ether  upon  the  Laryngeal  Muscles.  With  Felix  Semon. 
Brit.  Med.  Joum.,  Aug.  28  and  Sept.  4,  1886. 

1886.  A    case    of    Suppuration    of    the   Mastoid  Cells.      With 

remarks  on  the  prevention  of  septic  embolism  in  such 
cases.     Clin.  Soc.  Trans.,  xix. 

1887.  Notes  on  the  pathology  of  inveterate  Neuralgia  of  the 

Fifth  Nerve  :  illustrated  by  cases  treated  successfully 
by  avulsion  of  the  nerve  close  to  the  skull.  Trana. 
Odontol.  Soc,  June  1887. 

1887.  Remarks  on  Ten  Consecutive  Cases  of  operations  upon  the 
brain  and  cranial  cavity,  to  illustrate  the  details  and 
safety  of  the  method  employed.  Brit.  Med.  Joum., 
April  23,  1887. 

1887.  Trephining  in  the  Neohthic  Period.  Joum.  Anthropol. 
Inst.,  xvii.  100. 

?i887.  Recherches  Exp^rimentales  sur  I'ficorce  C^r^brale  des 
Singes,  d^montr^es  par  une  experience  actuelle  devant 
la  Socidte  de  Biologic  de  Paris.  Par  MM.  Charles  E. 
i^eevor  et  Prof.  Victor  Horsley.  London,  H.  K.  Lewis 
(undated). 


PUBLISHED  WRITINGS  343 

1887.  A  Note  on  the  means  of  Topographical  Diagnosis  of  Focal 
Disease  affecting  the  so-called  Motor  Area  of  the  Cerebral 
Cortex,     Amer.  Jouni.  Med.  Sc,  April  1887,  pp.  342-69. 

1887.  A  Minute  Analysis  (Experimental)  of  the  various  move- 

ments produced  by  stimulating  in  the  Monkey  different 
regions  of  the  Cortical  Centre  for  the  Upper  Limb,  as 
defined  by  Prof.  Ferrier.  With  C.  E.  Beevor.  Phil. 
Trans.  Roy.  Soc,  vol.  178,  B,  1887. 

1888.  Evidence   before    Parliamentary   Committee   on    Pleuro- 

pneumonia and  Tuberculosis  in  Cattle. 

1888.  Note  on  some  of  the  Motor  Functions  of  certain  Cranial 
Nerves,  and  of  the  three  first  Cervical  Nerves,  in  the 
Monkey  {Macactis  sinicus).  With  C.  E.  Beevor.  Proc. 
Roy.  Soc,  xliv.  269. 

1888.  A  Record  of  Experiments  upon  the  Functions  of  the 
Cerebral  Cortex.  With  E.  A.  Schafer.  Phil.  Trans. 
Roy.  Soc,  vol.  179,  B,  1888. 

1888.  A  further  Minute  Analysis  by  Electrical  Stimulation  of  the 
so-called  Motor  Region  of  the  Cortex  Cerebri  in  the 
Monkey  {Macacus  sinicus).  With  C.  E.  Beevor.  Phil. 
Trans.  Roy.  Soc,  vol.  179,  B,  1888. 

1888.  A  case  of  Cerebral  Abscess  successfully  treated  by  opera- 
tion.    With  Dr.  Ferrier.    Proc  Med.  Soc.  Lond.,  xi.  232. 

1888.  A  Case  of  Tumour  of  the  Spinal  Cord  :  removal :  recovery. 
With  Dr.  Cowers.     Trans.  Roy.  Med.  Chir.  Soc,  Ixxi. 

1888.  Reports  on  the  outbreak  of  Rabies  among  Deer  in  Rich- 
mond Park  during  the  years  1886-7.  With  Mr.  A.  C. 
Cope.     Eyre  and  Spottiswoode,  1888. 

1888.  On  Hydrophobia  and  its  '  Treatment,'  especially  by  the 
Hot-air  Bath,  commonly  termed  the  Bouisson  Remedy. 
Brit.  Med.  Joum.,  June  9,  1888. 

1888.  A  Case  of  Paralytic  Rabies  in  Man  ;  with  remarks.  With 
Dr.  J.  S.  Bristowe.     Clin.  Soc.  Trans.,  xxii. 

1888.  A  Case  of  Thrombosis  of  the  Longitudinal  Sinus,  together 

with  the  Anterior  Frontal  Vein,  causing  localised  foci 
of  Haemorrhage  which  produced  remarkably  localised 
Cortical  Epilepsy.     Brain,  April  1888. 

1889.  Die  Functionen  dcr  Motorischen  Region  dcr  Hindrindc. 

Deutsche  Med.  Wochenschrift,  No.  38,  1889. 

1889.  On  Rabies  ;  its  treatment  by  M.  Pasteur,  and  the  means 
of  detecting  it  in  suspected  cases.  Address  to  the 
Epidemiological  Society.  Brit.  Med.  Jouni.,  Feb.  16, 
1889. 


344  SIR  VICTOR  IIORSLEV 

1889.  Report  on  the  control  of  hasmorrhage  from  the  Middle 
Cerebral  Artery  and  its  branches  by  compression  of 
the  Common  Carotid.  With  Walter  G.  Spencer.  Brit. 
Med.  Joum.,  March  2,  1889. 

1889.  On  the  value  of  Differences  observed  in  the  Temperature 
of  the  two  sides  of  the  body,  as  symptomatic  of  cerebral 
lesions.     Brit.  Med.  Joum.,  June  22,  1889. 

1889.  Ein  Fall  von  RiickenmarksgeschwTjlst  mit  Heilung  durch 
Exstirpation.  Von  Dr.  W.  R.  Gowers  und  Victor 
Horsley.  Uebersetzt  und  den  Mitgliedem  der  Deutschen 
Gesellschaft  fiir  Chirurgie  bei  dem  18.  Congress  gewidmet 
bei  Dr.  Bemhard  Brandis.     Berlin,  Hirschwald,  1889. 

1889.  On  the  Central  Motor  Innervation  of  the  Larynx.     With 

FeUx  Semon.     Brit.  Med.  Joum.,  Dec.  21,  1889. 

1890.  On  the  relations  of  the  Larynx  to  the  Motor  Nervous 

System.    With  Felix  Semon.    Deutsch.  Med.  Wchnschr., 
1890,  No.  31. 

1890.  Du  Centre  Cortical  Moteur  Laryng^  et  du  Trajet  Intra- 
cerebral des  Fibres  qui  en  emanent.  With  Felix  Semon. 
Ann.  des  Mai.  de  I'Oreille  et  du  Larynx,  x\i. 

1890.  An  Experimental  Investigation  of  the  Central  Motor 
Innervation  of  the  Larynx.  With  Felix  Semon.  Phil. 
Trans.  Roy.  Soc,  vol.  181,  B  57,  1890. 

1890.  An  Experimental  Investigation  into  the  Arrangement  of 
the  Excitable  Fibres  of  the  Internal  Capsule  of  the 
Bonnet  Monkey  {Macacus  sinicus).  With  C.  E.  Beevor, 
Phil  Trans.  Roy.  Soc,  vol.  181,  B  52,  1S90. 

1890.  A  Record  of  the  Results  obtained  by  Electrical  Excitation 
of  the  so-called  Motor  Cortex  and  Internal  Capsule  in 
an  Orang-outang  {Simia  satyrus).  With  C.  E.  Beevor. 
Phil.  Trans.  Roy.  Soc,  vol.  181,  B,  1890. 

1890.  Sur  la  chirurgie  du  systcmc  nerveux  central.  Translation 
of  Horsley 's  address  at  Int.  Med.  Congress  in  Berlin. 
Mercredi  Mddical,  Aug.  27,  1890. 

1890.  Note  on  a  possible  means  of  arresting  the  progress  of 

Myxoedema,  Caclicxia  strumipriva,  and  aUicd  diseases. 
Brit.  Med.  Joum.,  Feb.  8,  1890. 

1891.  On  the   Analysis  of   Voluntary  Movement.     Nineteenth 

Century,  June,  1891. 

1 891.  Ueber  den  Gebrauch  der  Elektricitat  fiir  die  Localisirung 
der  Erregungserscheinungen  im  Centralnervensystem. 
With  Francis  Gotch.    Ccntralbl.  f.  Phys.,  Jan.  31,  1891. 


PUBLISHED  WRITINGS  345 

1891.  On  the  Mammalian  Nervous  System,  its  Functions,  and 
their  Localisation  determined  by  an  Electrical  Method. 
The  Croonian  Lecture  for  1891.  With  Francis  Gotch. 
Phil.  Trans.  Roy.  Soc,  1891. 

1891.  Die  Function  der  Schilddriise  :  eine  historisch-kritische 
Studie,     Contributed  to  the  Virchow  Festschrift,  Bd.  i. 

1891.  Remarks  on  the  various  surgical  procedures  devised  for  the 
relief  or  cure  of  Trigeminal  Neuralgia  (Tic-douloureux). 
With  James  Taylor  and  Walter  S.  Colman.  Brit.  Med. 
Joum.,  Nov.  28,  Dec.  5,  Dec.  12,  i8gi. 

1891.  On  a  Case  of  Traumatic  Abscess  in  the  neighbourhood  of 
the  left  angular  gyrus,  with  right  hemianopsia  and  word- 
bUndness,  treated  by  operation.  With  C.  E.  Beevor. 
Trans.  Ophthalmol.  Soc,  xii. 

1891.  On  the  Changes  produced  in  the  Circulation  and  Respiration 
by  increase  of  the  Intra-cranial  Pressure  or  Tension. 
With  Walter  Spencer.  Phil.  Trans.  Roy.  Soc,  vol.  182, 
B,  1891. 

1891.  The  Structure  and  Functions  of  the  Brain  and  Spinal  Cord. 

Fullerian  Lectures  for  1891,  London,  Griffin  and  Co., 
1892. 

1892.  Topographical  Relations  of  the  Cranium  and  Surface  of 

the  Cerebrum.  Royal  Irish  Academy:  Cunningham 
Memoirs,  Dublin,  1892,  vol.  vii.  pp.  306-55. 

1893.  Introduction  to  '  The  Chemistry  of  the  Blood  ;   and  other 

Scientific  Papers  by  the  late  L.  C.  Wooldridge.  Arranged 
by  Victor  Horsley  and  Ernest  StarUng.'  London, 
Kegan  Paul,  1893. 

1893,  A  Clinical  Lecture  on  Paraplegia  as  a  result  of  Spinal  Caries 
(Compression-Myehtis)  and  its  Treatment.  Clin.  Joum., 
March  15,  1893. 

1893.  The  Surgical  Treatment  of  Nervous  Diseases.  A  Post- 
Graduate  Lecture.  Med.  Press  and  Circular,  April  5, 
1893. 

1893.  The  Discovery  of  the  Physiology  of  the  Nervous  System. 
Address  at  meeting  in  Nottingham  of  the  British 
Association.     Med.  Press  and  Circular,  Sept.  27,  1893. 

1893.  Discussion    on    the    Treatment    of    Cerebral    Tumours. 

Address  at  Newcastle.  Brit.  Med.  Joum.,  Dec  23, 
1893. 

1894.  A  further  Minute  Analysis  by  Electrical  Stimulation  of  the 

so-called  Motor  Region  (I'^acial  Area)  of  the  Cortex 
Cerebri  in  the  Monkey  {Macacus  sinicus).  With  C.  E. 
Beevor.  Phil.  Trans,  Roy.  Soc,  vol.  185.  B,  TM.  i., 
1894. 


346  SIR  VICTOR  HORSLEY 

1894.  On  the  Mode  of  Death  in  Cerebral  Compression,  and  its 
Prevention.     Quarterly  Medical  Journal,  July  1894. 

1894.  The  Destructive  Effects  of  Projectiles.     Royal  Institution 

Lecture,  April  6,  1894. 

1895.  The  Differential  Diagnosis  of  Cerebral  Tumours  :    with 

some  remarks  on  treatment.    Clin.  Joum.,  Feb.  13, 1895. 

1895.  Five  cases  of  Leontiasis  Ossium,  in  three  of  whicli  the 
disease  was  removed  by  operation.  Practitioner, 
July  1895. 

1895.  The  Results  of  Operative  Treatment  of  Injury  or  Disease 
of  the  Cervical  Vertebrae.     Lancet,  Aug.  17,  1895. 

1895.  Introductory  Address  deUvered  at  the  openuig  of  the  winter 

session  of  the  Sheffield  School  of  Medicine.     Quarterly 
Med.  Joum.,  Oct.  1895. 

1896.  Traumatic  Neurasthenia.     A  lecture  at  Univ.  Coll.  Hosp. 

Clin.  J(jum.,  March  4,  1896.     See  also  Proc.  Med.  Soc. 
Lond.,  XX.  216. 

1896.  The  duties  and  functions  of  the  General  Council  of  Medical 

Education  and  Registration.     Med.  Magazine,  v.  109. 

1897.  On  the  Diseases  of  the  Spinal  Cord  requiring  Surgical 

Treatment.     Clin.  Joum.,  Jan.  13,  1897. 

1897.  On  the  relations  between  the  Cerebellar  and  other  Centres 
(namely,  Cerebral  and  Spinal)  with  especial  reference 
to  the  action  of  antagonistic  muscles.  With  Dr.  Max 
Lowenthal.     Proc.  Roy.  Soc,  vol.  Ixi.,  1897. 

1897.  Torticollis.     Clin.  Joum.,  June  30,  1897. 

1897.  On  the  effects  produced  on  the  circulation  and  respiration 
by  Gunshot  Injuries  of  the  cerebral  hemispheres.  With 
Dr.  S.  P.  Kramer.  Phil.  Trans.  Roy.  Soc,  series  B, 
vol.  188,  1897. 

1897.  Short  note  on  Sense-organs  in  Muscle  ;  and  on  the  pre- 
servation of  Muscle-spindles  in  conditions  of  extreme 
muscular  atrophy,  following  section  of  the  motor  nerve. 
Brain,  Pt.  Ixxix.,  1897. 

1897.  Das  Sauerstofibediirfniss  des  Organismus.  Miinch.  Med. 
Wochenschrift,  No.  19,  1897. 

1897.  Methylenblaufiirbung  der  Blutkorperchen.     Miinch.  Med. 

Wochenschrift,  No.  23,  1897. 

1898.  A  Contribution  towards  the  Determination  of  the  Energy 

developed   in   a  Nerve  Centre.     Presidential  Address 
to  the  Neurological  Society.     Brain,  Pt.  Ixxxiv.,  1898. 

1898.  On  the  Excitable  Fibres  of  the  Cms  Cerebri.  With  Dr. 
C.  E.  Beevor,  Fourth  International  Physiological 
Congress,  Cambridge.     Joum.  Phys.,  xxiii. 


PUBLISHED  WRITINGS  347 

1898.  On  Penetrating  Wounds  of  the  Central  Nerv^ous  System. 
Clin.  Joum.,  xii.  261. 

1898.  The  true  interpretation  to  be  placed  on  the  Medical  Acts. 
Suppl.  to  Clin.  Joum.,  Feb.  9,  1898. 

1898.  On  the  work  of  the  General  Medical  Council.     Abstract  of 

Address  to  the  Manchester  Medico-Ethical  Association. 
Lancet,  Dec.  24,  1898. 

1899.  Roman  Defences  of  South-East  Britain.     Royal  Institu- 

tion Lecture,  Feb.  3,  1899. 

1899.  On  Injuries  to  Peripheral  Nerves.     Practitioner,  Aug.  1899. 

1899.  On  the  rational  treatment  of  Goitre.    Address  to  the  North- 

West  London  CUnical  Society,  Oct.  27,  1898.  Clin. 
Joum.,  March  8,  1899. 

1900.  The  Effect  of  Alcohol  on  the  Human  Brain.     Lees  and 

Raper  Memorial  Lecture.  See  Brit.  Joum.  Inebriety, 
iii.  69. 

1901.  A  Study  of  the  Degenerations  observed  in  the  Central 

Nervous  System  in  a  case  of  Fracture  Dislocation  of 
the  Spine.  With  Dr.  F.  H.  Thiele.  Brain,  Pt.  xcvi., 
1901. 

1902.  On  the  Pallio-tectal  or  Cortico-mesencephalic  System  of 

Fibres.     With  Dr.  C.  E.  Beevor.     Brain,  Pt.  c,  1902. 

1903.  The    Purposes    and    Maintenance    of    our    Universities. 

Address  at  Birmingham.  Birmingham  Medical  Re- 
view, October  1903. 

1904.  On  Tactile  Sensation.     Practitioner,  Ixxiii.  581. 

1904.  Evidence  before  Parliamentary  Committee  on  Physical 

Deterioration. 

1905,  On  the  Intrinsic  Fibres  of  the  Cerebellum,  its  Nuclei,  and 

its  Efferent  Tracts.  With  R.  H.  Clarke.  Brain.  Pt. 
cix.,  1905. 

1905.  On  a  Trigeminal- Aural  Reflex  in  tlie  Rabbit.  Brain, 
Pt.  cix.,  1905. 

1905.  An  Address  on  Ha^morrlioids.     CHn.  Journ.,  Feb.  15,  1905. 

1905.  The  Cerebellum  :  its  relation  to  Spatial  Orientation  and  to 

Locomcjtion.  The  Boyle  Lecture  for  1905.  Bale,  Sons, 
and  Danielsson,  London,  1906. 

1906.  Note  on  the  Taenia  Pontis.     Brain,  1906. 

1906.  Upon  the  Orientation  of  Points  in  Space  by  the  muscular, 
artlirodial,  and  tactile  senses  of  the  upper  limbs,  in 
normal  individuals  and  in  blind  jxTsons.  With  Dr.  R. 
Townlcy  Slingcr.     Brain,  Pt.  cxiii.,  1906. 


348  SIR  VICTOR  HORSLEY 

1906.  Note  on  apparent  Re-representation,  in  the  Cerebral  Cortex, 
of  the  type  of  Sensory  Representation  as  it  exists  in 
the  Spinal  Cord.  With  Dr.  Colin  K,  Russel.  Brain, 
Pt.  c.xiii.,  1906. 

1906.  On  Dr.  HughUngs  Jackson's  Views  of  the  Functions  of 
the  Cerebellum,  as  illustrated  by  Recent  Research.  The 
Hughlings  Jackson  Lecture  for  1906.  Brain,  Pt.  cxvi,, 
1906 ;  Brit.  Med.  Joum.,  1907,  i.  803. 

1906.  On  the  Technique  of  Operations  on  the  Central  Nervous 
System.  Address  in  Surgery,  Toronto,  Brit.  Med. 
Joum.,  Aug.  25,  1906 ;  Lancet,  1906,  ii.  484. 

1906.  Address   on   Temperance  :     given    in   Toronto.     Medical 

Temperance  Review,  October,  1906. 

1907.  Alcohol  and  the  Human  Body.     With  Dr.  Mary  Sturge. 

Macmillan,  London,  1907.     Fifth  edition,  1915. 

1907.  Evidence  before  the  Royal  Commission  on  Experiments 

on  Animals. 

1908.  Note  on  the  existence  of  Reissner's  Fibre  in  Higher  Verte- 

brates.    Brain,  Pt.  cxxi.,  1908. 

1908.  The  Structure  and  Functions  of  the  Cerebellum  examined 
by  a  New  Method.  With  R.  H.  Clarke.  Brain,  Pt.  cxxi., 
1908. 

1908.  The  Operative  Treatment  of  Optic  Neuritis.     Address  at 

Oxford.     Ophthalmoscope,  Sept.  1908. 

1909.  On  the  Cervical  Spino-bulbar  and  Spino-cerebellar  Tracts, 

and  on  the  question  of  Topograpliical  Representation  in 
the  Cerebellum.  With  A.  Salusbury  MacNalty.  Brain, 
Pt.  cxxvii.,  1909. 

1909.  Description  of  the  Brain  of  Mr.  Charles  Babbage,  F.R.S. 
Phil.  Trans.  Roy.  Soc,  Series  B,  vol.  200,  pp.  117-31, 
1909. 

1909.  A  CUnical  Lecture  on  Chronic  Spinal  Meningitis :  its 
Differential  Diagnosis  and  Surgical  Treatment.  Brit. 
Med.  Joum.,  1909,  i.  513.  Translated  in  Joum.  de 
M6d.  et  de  Chir.  Prat.,  June  10,  1909. 

1909.  Alcohol  and  the  National  Life.  An  address  at  Whitefield's 
Tabernacle,  Jan.  1909. 

1909.  The  Cerebellum.  The  Cavendish  Lecture.  West  London 
Medical  Journal,  1909. 

1909.  The  Function  of  the  so-called  Motor  Area  of  the  Brain, 
The  Linacre  Lecture.  Brit.  Med.  Joum.,  July  17,  1909. 
Reprinted :  British  Medical  Association,  London, 
1909. 


PUBLISHED  WRITINGS  349 

1910.  The  Mesencephalic  Root  of  the  Fifth  Nerve.  VVitli  Dr. 
Otto  May.     Brain,  October,  1910. 

1910.  Die  chirurgische  Behandlung  der  intrakraniellen  Ge- 
schwiilste,  im  Gegensatz  zu  der  abwartcnden  Therapie 
bctrachtet.  Vortrag,  gehalten  auf  der  4.  Vcrsammlung 
der  Gesellschaft  Deutscher  Ncrvenarzte  am  6  Oktober, 
1910.  Deutsche  Ztschr.  f.  Ncrvenh.,  1911,  xh.  91. 
Also  published  in  Enghsh. 

1910.  The  Topographical  Diagnosis  of  Tumours  of  the  Cerebral 
Hemisphere.  University  College  Hospital  Magazine, 
i.  I,  June  1910. 

1910.  A  Paper   on   Optic   Neuritis,  '  Choked  Disc,'  or  '  Papill- 

cedema.'  Address  at  Belfast.  Brit.  Med.  Joum.,  March 
5,  1910.  Reprinted  :  British  Medical  Association, 
London,  1910. 

191 1.  Preliminary  Note  on  experimental  investigations  on  the 

Pituitary  Body,  With  Dr.  Handelsmann.  Brit.  Med. 
Joum.,  Nov.  4,  1911. 

191 1.  On  some  of  the  biological  and  statistical  errors  in  the  work 
on  Parental  Alcoholism  by  Miss  Elderton  and  Professor 
Karl  Pearson,  F.R.S.  With  Dr.  Mary  Sturge.  Brit. 
Med.  Joum.,  Jan.  14,  1911. 

1911.  Factors  which  conduce  to  success  in  the  treatment  of 

otogenic  Brain-abscess.  Proc.  Roy.  Soc.  Med.,  1911-12, 
v.,  Otol.  sect.,  pp.  45-72. 

1912.  Preliminary  Report  on  the  Forcible  Feeding  of  Suffrage 

Prisoners.  With  Agnes  F.  Saviil,  M.D.,  and  C.  W. 
Mansell  MouUin,  F.R.C.S.     Lancet,  Aug.  24,  1912. 

1914.  Evidence  before  the  Royal  Commission  on  Venereal  Dis- 
eases. 

1914.  Present-day  lessons  from  the  life-work  of  Mitchell  Banks. 
The  Sir  WiUiam  Mitchell  Banks  Memorial  Lecture. 
Medical  Press,  Oct.  14,  1914. 

1914.  On  the  Reform  of   the    Vital   Statistics   of   the    Nation. 

Brit.  Med.  Journ.,  Nov.  7,  1914. 

1915.  The  Brotherhood  Movement  and  the  War.     Brotherhood 

Journal.  April  1915. 

1915.  On  the  Alleged  Responsibihty  of  the  Medical  Profession 
for  the  rcintroduction  of  the  Rum  Ration  into  tlic 
British  Army.     Brit.  Med.  Journ.,  Jan.  30,  1915. 

1915.  Remarks  on  Gunshot  Wounds  of  the  Head.  Brit.  Med. 
Joum.,  Feb.  20,  1915  ;  and  Proc.  Med.  Soc.  Lend., 
1915- 


INDEX 


Aberdeen :  Hon.  Degree  given  to 
Horsley  by  the  University,  211. 

Acad6mie  de  Medecine  de  France,  196. 

Acland  Troyte,  Colonel,  326. 

Acromegaly,  Pierre  Marie's  study  of, 
123. 

Adams,  Mr.  William,  117. 

Advancement  of  Medicine  by  Research, 
Association  for,  148. 

Alcohol,  200,  211,  230-254:  results  of 
small  quantities,  231-233  :  reduction 
of  alcohol  in  hospitcds,  231,  236 : 
alcohol  and  the  national  life,  230  : 
effects  of  parental  alcoholism  on 
children,  239-243. 

'  Alcohol  and  the  Human  Body,'  by 
Horsley  and  Dr.  Mary  Sturge,  236- 
238,  252,  303,  332. 

Alcoholic  paralysis,  231. 

Alexandria,  297-312. 

Allbutt,  Sir  T.  Cliflord,  191. 

Allen,  Capt.,  311. 

Amarah,  326-333,  336-340. 

Ambidexterity,  Horsley's,  263. 

American  Physicians  and  Surgeons, 
Congress  of  (1888),  136. 

Surgical  Association,  139. 

Ammunition  (1914)  :  experimental 
study  of,  288. 

Anaesthetics:  Horsley's  experiments  on 
himself,  40,  232  :  on  animals,  96,  147  : 
methods  of  administering  chloroform, 
174,  184  :  teaching  to  students,  187, 
191 :  Government  Committee,  191  : 
Hyderabad  Commission,  174. 

Anaesthetists,  Society  of,  174. 

Annandale,  Prof.,  120. 

Antagonistic  muscles,  experimental 
study  of,  164. 

Anthropological  Institute,  124. 

Antiseptic  surgery  a  cause  of  the  reduc- 
tion of  alcohol,  236. 

wax,  Horsley's  use  of,  lao. 

'  Anti-vivisection,'  52,  81,  83,  89,  147. 

Anzac  Medical  Society,  302. 

Arderne- Wilson,  Capt.,  309. 

Arm-area  :   removal  of,  194. 

Armour,  Mr.  Donald,  117. 

Armstrong,  Lord,  48. 

Arrest  of  correlated  development  of 
brain  ami  hand,  28. 

Artists'  Corps,  the,  22,  24. 

Aschaflcnburg's  experiments  with  al- 
cohol, 231. 

Asbar,  319. 

Aspinall,  Major,  303. 


I  Assistant-Professorship  of  Pathology, 
Univ.  Coll.  (1882),  43. 

Association  of  Fellows  of  Royal  College 
of  Surgeons,  220. 

of  Members  of  Royal  College  of 

Surgeons,  221. 

Athenaeum,  membership  without  bal- 
lot, 157. 

Australian  Hospital,  Wimereux,  294. 

Avebury,  Lord,  68. 

B 

Babbage,  Mr.  Charles,  F.R.S.  :  Hors- 
ley's study  of  his  brain,  188. 

Babtie,  Sir  William,  307. 

Bacteria,  '  or  their  antecedents,'  In 
healthy  tissues,  28. 

Ballance,  Sir  Charles,  117,  121,  127. 

Barker,  Mr.  Arthur,  119. 

Barlow,  Sir  Thomas,  201,  235. 

Basrah,  320. 

Bastian,  Dr.  Charlton,  27,  116,  159. 

Bateman,  Dr.  A.  G.,  214. 

Batt,  Mr.  Ernest,  78. 

Beck,  Mr.  Marcus,  30. 

Beevor,  Dr.  C.  E.,  29,  95,  loo-iio,  141, 
150,  165,  170. 

Berlin,  visit  to  (1881),  41  :  International 
Medical  Congress  (1890),  138. 

Bernard,  Claude,  on  the  ductless  glands, 
56. 

Berry,  Mr.  James,  200. 

Birchcr,  Dr.,  64. 

Birmingham,  temperance  addresses  in, 
244. 

Blenkinsop,  Colonel,  316. 

Board  of  Agriculture,  80,  88. 

Body,  Captain  T.  M.,  337. 

Bombay,  314. 

to  Basrah,  316-318. 

Bond,  Mr.  C.  J.,  29,  30,  39,  45,  266,  289. 

'  Bouissoii  Batli,'  the,  82. 

Boyce,  Prof.  Rubcrt,  149,  159. 

Boyle  Lecture  at  Oxford,  179. 

Boys,  Prof,  Vernon,  155. 

'  Boys  hihcrit  their  brains  from  their 
niothiTS,'  204. 

Bradford,  Sir  J.  Rose,  51. 

Brain,  early  papers  on  disease  or  Injury 
of,  28,  49  :  experiment  il  study  of 
localisation  of  function  (1884-1890), 
90-113  :  first  papers  on  brain-surgery, 
121,  122,  136.  Other  addresses  on 
brain-surgery  :  Berlin,  i^8  ;  New- 
castle, 150  ;  Toronto,  183  ;  Cam- 
bridge, 193  ;  Berlin,  196  ;  London, 
390  ;   Alexandria,  306. 

S6l 


352 


SIR  VICTOR  HORSLEY 


Bramwcll,  Sir  Frederick,  48,  266. 

Breccia,  Sijcnor,  306. 

Bristowc,  Dr.,  77. 

British  Association,  Nottingham  meet- 
ing (1893),  151. 

General  Hospital,  Amarah,  338. 

Hospital,  Wimereux,  289-294. 

Medical  Association,  222-229,  275. 

Briton  Rivi6rc,  Mr.,  84. 

Broadbent,  Sir  William,  235. 

Broca  Museum  of  Anthropology,  124. 

'  Broca's  convolution,'  91. 

Bro.lic,  Prof.  T.  G.,  51. 

Brotherhood  Movement,  the,  256. 

Brown  Institution,  50-53,  78-82. 

Brown-Soquard,  Dr.,  123,  142. 

Brunei,  Isambard,  3,  12. 

Brunton,  Sir  T.  Lauder,  on  rabies,  69, 
70. 

Buckland,  Miss,  125. 

Bullet-wounds  of  brain,  experimental 
study  of,  154-157,  288. 

Burdon  Sanderson,  Sir  John,   17,  51, 

69-73- 
Buxton,  Dr.  Dudley,  29,  30,  32. 
Buzzard,  Dr.  Farquhar,  186. 


'  Cachexia  strumipriva,'  57-67. 

Cadbury,  Mr.,  306. 

Caillard,  Mme.,  301. 

Callcott,  Sir  Augustus,  3. 

John  Wall,  3- 

Cameron  Prize,  Univ.  Edin.,  151. 

Cardiff  Medical  Society,  146. 

'  Cardinal  points '  of  the  National 
Insurance  Act,  225. 

Cartwright  Lectures,  163. 

Cavendish  Lecture,  the,  192. 

Cavenflish  Square,  the  Horsleys'  house 
in,  142. 

Cerebellum,  clinical  and  experimental 
study  of  the,  177-178,  179,  189,  191, 
192. 

Cerebral  abscess,  operation  for,  118, 
133.  137,  154,  200. 

aimpression,  clinical  and  experi- 
mental study  of,  137. 

ha}morrhage,  experimental  study 

of,  137. 

tumour :     results   of    treatment, 

with  and  without  operation,  196, 
201  :   choice  of  operation,  ibid. 

Cervical  spinal  disease,  operative  treat- 
ment of,  157. 

Chalice,  the  :  question  of  risk  of  in- 
fection, 29. 

Chappell,  Mr.  Salter,  40. 

Charcot,  Prof.,  55,  121. 

Charlotte  Street,  Fitzroy  Square  (1882), 
42. 

Charterhouse,  14. 

Chemistry,  the  foundation  of  medical 
education,  159. 

Cheyne,  Sir  W.  Watson,  44,  123. 

Children,  Horsley's  love  toward,  270, 
274. 

Christian  Basis  of  Human  Action  :  a 
Brotherhood  address,  259. 


Christiansen,  Dr.,  166. 

Church   Congress,   Folkestone    (1892), 

146,  213. 
Clark,  Sir  Andrew,  68. 
Clarke,  Miss  Alys,  304. 

Mr.  R.  H.,  178,  184,  189. 

Clinical  Society's  Report  on  Myxoedema, 

63. 
Cobbe,  Miss  Frances  Power,  147. 
Cohnhoim,  Prof.,  42. 
College    of    Surgeons,    36,   49 :     War 

Museum,   155  :    Council,   171  :    F'el- 

lows  and  Members,  220. 
Colman,  Dr.  Walter  S.,  142. 
Compression  of  the  brain,  clinical  and 

experimental  study  of,  153-157. 
Compression-myelitis,  operative  treat- 
ment of,  149,  200. 
'  Condiments,'  arguments  against,  29. 
'  Confusion-theory,'  Beevor  s  and  Hors- 
ley's, lOI. 
Consultant,  M.E.F.,  Horsley  appointed, 

301. 
Convulsive  centres,  Nothnagel's  theory 

of,  122. 
Coomber,  Miss  Helen,  291. 
Cope,  Mr.  A.  C. :  report  on  rabies  among 

deer,  81. 
Cornwall,  holidays  in,  a6,  32. 
Coroners'  law,  223. 
Cox,  Dr.  Alfred,  213,  223. 
Craig,  Dr.  Maurice,  242. 
Cranbrook,  5,  14. 
Cranbrook  School,  13. 
Cranial   measurements   in   relation    to 

brain-surgery,  125,  146. 
Cretinism,  sporadic  and  endemic,  54-67. 
CrUe,  Prof.,  186. 
Croonian  Lecture,  139. 
Cruelty  to  Animals   Act    (1876),    127, 

187. 
Cunliffe,  Mr.  John,  51. 
Cunningham     Memoirs,     Royal     Irish 

Academy,  146. 
Curling,  Mr.,  54. 

Gushing,  Prof.  Harvey,  137,  180. 
Cutlack,  Mr.  Frank,  121. 


D 

Death-certificates :  need  of  strict 
veracity,  and  of  privilege,  174,  209, 
211,  234. 

Decompression,  operation  for,  137, 
184,  197. 

Deer  in  Richmond  Park  :  264  deaths 
from  rabies  (1886-87),  81. 

Delhi,  315,  318. 

Demr)cratic  Control,  Union  of,  288, 
306,  328. 

Demonstration  of  experiments  on  ani- 
mals, 160. 

Dendy,  Miss  Mary,  240. 

Dental  Surgery,  London  School  of,  191. 

Derby,  the  (1915),  300. 

'  Disinterested  Management '  of  public- 
houses,  246. 

Distemper  :  reduced  by  enforcement 
of  muzzling,  79,  80. 


INDEX 


353 


Dog   Owners'    Protection    Association, 

84-87. 
Dominion  Temperance  Alliance,  184. 
Douglas,  Dr.  W.,  224. 
Doweswell,  Mr.  G.  F.,  79. 
Drewitt,  Dr.  Dawtrey,  58. 
Drinking-water  not  steniisecl  by  alcohol 

put  in  it,  249,  323. 
Du  Maurier,  George,  147. 
'  Dura-dum  '  bullets,  288. 
Dunhill,  Dr.  James,  200. 
Dunlop,  Major,  302. 


Edinburgh,  Horsley's  lecture  in,  151. 

Eisselsberg,  Dr.  von,  64. 

Elderton,  Miss,  239-243. 

Electrical  currents  in  the  body,  157. 

Electrolysis  in  experimental  sHidy  of 
cerebellar  nuclei,  i8g. 

Electro-motive  changes  in  spinal  cord, 
experimental  study  of,  134,  140. 

Elliot  Smith,  Prof.,  178. 

Embolism  :  ligature  of  internal  jugular 
vein,  121. 

Encepbalocele,  notes  on  a  case  of,  49. 

Engine-ruled  paper,  Horsley's  use  of, 
105. 

Epidemiological  Society,  the,  77. 

Epilepsy,  experimental  study  of,  122, 
123,  146,  160. 

Erichsen,  Sir  John,  121. 

Ether-vapour  :  local  action  on  laryn- 
geal muscles,  iii. 

Ewald,  Prof.,  20. 

Exophthalmic  goitre,  158,  200. 

Experiments  on  animals,  demonstra- 
tion of,  138,  160  :  Horsley's  evidence 
before  Royal  Commission,  186. 

Ezra's  tomb  (Mesopotamia),  322. 


Fagge,  Mr.  Hilton,  54. 
Falmouth,  sea-trip  to,  25. 
Feeding-movements,  a  theory  rii,  104. 
Fell,  Colonel,  336. 
Female  Suflrage,  195,  201,  203-211. 
Fenwick,  Mr.  E.  Hurry,  66. 
Fergusson,  Inspector-General,  250. 
Fcrrier,  Sir  David,  03,  iii,  137,178,179. 
Filayieh  (.Mesopotamia),  334. 
Filliter  Exhibition,  the,  25. 
Finzi,  Dr.  Neville  S.,  199. 
Fleminp,  Dr.  George,  69,  84. 
Flemmiiig,  Dr.  Charles,  275 
Flight-niovements,  a  theory  of,  109. 
Flowers  for  the  Hospital,  35,  37. 
Fontamcbleau,  holiday  at,  25. 
Forcible  feeding  of  Suffrage  prisoners, 

200,  204. 
Poster,  Prof.  Carey,  16. 
Fothcrgillian   Prize  and   Lecture,    157, 

158 
Fox,  Dr.  E.  L.,  66. 
France,  the  Temperance  movement  in, 

234. 
Fritsch  and  Hitzig,  92. 
Fry,  Sir  Edward,  i(>g. 


Fuller-Maitland,  Mr.  J.  A.,  71. 
Fullerian   Professorship  and   Lectures, 
Royal  Institution,  139,  146. 


Galen, and  the  experimental  method, 90. 
Gallipoli,  Horsley  at,  302,  304,  312. 
Gallon       Laboratory       for       National 

Eugenics,  239. 

Sir  Francis,  125. 

Galvano-cautery,   Horsley's  disuse  of, 

115- 
Gardner,  Dr.,  of  Melbourne,  164. 
Gasserian    ganglion,    removal    of    the, 

142,  165,  190,  192. 
General  Elections  of  1910,  195. 

Medical  Council,  158,  165,  216-220. 

Germany  :     walking    tour   (1877),    18  : 

Leipzig,  41  :    Berlin,    41,    138,    196, 

197  :    German  statements  about  the 

War,  286,  288. 
Gibson,  Dr.  Lockhart,  67. 
Glioma  and  glio-sarcoma  of  the  brain, 

138,  150,  184,  201. 
Godlee,  Sir  Rickinan  J.,  59,  89. 
Goodbody,  Major,  I. M.S.,  323. 
Goitre,  54-67. 
Goltz,  Prof.,  20,  94,  138. 
Gotch,  Prof.,  18,  95,  128,  139. 

Mrs.,  5,  22,  129. 

Gower  Street :  early  years  in  practice, 

46. 
Gowers,  Sir  William,  27,  126  :  letters 

from,  162,  170. 
Grant  Medical  College,  Bombay,  317. 
Greenfield,  Prof.,  51. 
Griinbaum,  Prof.,  no,  142,  194. 
Gull,  Sir  \Villiam,  54. 
Gunshot     wounds,     heavily     infected, 

treatment  of,  289  :    gunshot  wounds 

of  head,  290. 
GuydeChauliac,on  the  perfect  surgeoo, 

31- 

H 

Hadden,  Dr.  W.  B.,  58. 

Haden,  Charles,  3. 

Sir  Francis,  3,  7. 

Thomas,  3. 

HiPmostasis  by  application  of  living 
tissue,  210. 

Halle,  University  of,  152. 

Halliburton,  Prof.,  61. 

Hankin,  Dr.  E.  H.,  145. 

Harborouglj  Division  :  Horsley's  can- 
didature, 200,  203-208,  255. 

H.ncourt,  Mr.  A.  G.  Vernon,  174. 

Hardy,  F.  D.,  5,  10. 

Harley,  Prof.  Vaughan,  139. 

'  Harness's  electric  belts  '  :  legal  action, 
157. 

Harris,  Dr.  Butler,  152,  157. 

Hartley,  Sir  William,  23S. 

Hayler,  Mr.  Guy,  247,  241),  25a. 

Held,  Dr.  Henry,  171,  175. 

He.iith,  Ministry  of,  21 1,  255. 

Hralli,  Mr.  Christopher,  145,  264. 

Heidrnh.iiii,  Prof  ,  149. 


354 


SIR  VICTOR  HORSLEY 


HerriBgham,  Sir  Wilmot,  201. 

Hey  Groves  splint,  the,  303. 

High  Row,  Kensington,  4. 

Hill,  Dr.  Leonard,  153. 

Hine,  Bishop,  20 

Holidays,  125,  265,  307. 

Holmes,  Dr.  Gordon,  i86. 

Home-life,  273. 

Hooper,  Dr.,  iii. 

Hoppe-Seyler,  Prof.,  20. 

Horsley,  Gerald,  4,  10,  142,  262. 

John  Callcott,  3-8,  11,  26. 

Mrs.  J.  C,  7- 

Lady,  48,  50,  88,  128,  204,  265. 

Capt.  Oswald,  152,  305. 

Miss  Pamela  (Mrs.  Stanley  Robin- 
son), 297,  303,  3<j6,  3-0.  330,  334- 

Capt.  Siward,  139,  208,  304. 

Miss  Sophy,  3,  41. 

Sir  Victor.      Childhood  and  early 

years,  3-10:  Cranbrook  School,  11-14: 
medical  student,  15-36  :  house- 
surgeon,  36-40  :  surgical  registrar, 
43 :  engagement,  48  :  work  at 
Brown  Institution,  study  of  thyroid 
gland,  and  of  rabies,  50-89  :  study  of 
localisation  of  function  in  brain,  90- 
113  :  Hospital  appointments,  116  : 
first  operation  at  Queen  Square,  120  : 
first  removal  of  tumour  of  spinal  cord, 
125  :  marriage,  129 :  at  Berlin 
(1890),  138  :  Royal  Society  medallist, 
152:  at  Toronto  {1906),  183:  at 
Berlin  (1910),  196:  Lannelongue 
Prize,  199.  Work  of  professional 
politics  :  the  Medical  Defence  Union, 
the  General  Medical  Council,  the 
British  Medical  Association,  the 
National  Insurance  Act,  etc.,  212-229. 
Work  of  national  politics  :  female 
suffrage,  and  other  measures  of  re- 
form, 195-229.  The  fight  against 
alcohol,  230-254  :  ethical  teaching, 
and  Brotherhood  addresses,  255-262. 
Hospital  practice  and  private  prac- 
tice ;  holidays ;  and  the  home  life 
at  25  Cavendish  Square,  263-281. 
The  War  :  Horsley  in  London,  and 
at  the  British  Hospital,  Wimereux, 
285-294  :  Egypt,  Gallipoli,  Mersa 
Matruh,  294-312  :  India,  313-316  : 
Mesopotamia,  318-340. 

Col.  Walter,  4,  24. 

William,  3. 

Hospitals :     less    alcohol    given,    and 

more  milk,  231. 
House-surgeoncy,  36-40. 
Housing  and  alcoholism,  191. 
Howells'  '  A  Chance  Arquaintance,'  48. 
Howitz,  Dr.,  67. 
Howse,  Sir  Neville,  302. 
Huddersfield  :       Horsley     chosen     as 

Liberal  candidate,  208. 
Hughes  Bennett,  Dr.,  115. 
Hughlings  Jackson,  Dr.,  94,  loi,  107, 

120,  161,  180,  193. 
Huguier's    experiments    on    effects   of 

projectiles,  155. 
Hunter,  John,  280. 


Huxley,  Dr.  H..  265. 

Hygiene  and  temperance  to  b«  taught 

in  schools,  224,  235. 
Hyndman,  Mr.  I-rancis,  198. 
Hyperpyrexia  in  cerebral  cases,  141. 

I 
India,  314-318. 
Indian  Field  Ambulances,  322,  336. 

Medical  Service  and  Government 

of  India,  310,  317,  331. 

Stationary    Hospital,  6ist,   323  : 

12th,  329. 

Intensive     treatment    against    rabies, 

70,  77- 
'  Internal  capsule,'  the,  104. 
International  Medical  Congress,  Berlin 

(1890),  138  :    London  (1913),  201. 
International    Physiological    Congress, 

Cambridge  (189K),  165. 
Introductory  addresses,  141,  158,  159, 

171. 
Italian  Society  of  Neurology,  200, 
Italy,  a  holiday  in  (1882),  45. 


'  Jacksonian  epilepsy,'  94,  loi,  124. 
Jameson,  Sir  Starr,  29. 
Jenner,  Sir  William,  126. 
Johne's  disease  of  rattle,  51. 
Johns  Hopkins  Hospital,  187. 
Joyce,  Dr.  Thomas,  16. 
Jugular    vein  :     ligature,    to    prevent 
embolism,  121. 

K 

Karslake,  Mr.  Frank,  84. 

Keen  of  Philadelphia,  Dr.,  141,  164. 

Keynes,  Mr.  J.  M.,  242. 

Kidd,  Dr.  Percy,  126. 

King-Hall,  Admiral  Sir  George,  248. 

Kingsley,  Charles,  24. 

Kitchener,  Lord,  288. 

Knight,  General,  318. 

Knighthood,  honour  of  (1Q02),  170. 

Kocher,  Prof.,  57,  64,  i55- 

Kraepelin's  experiments  with  alcohol, 

231. 
Kramer,  Dr.  S.  F.,  154,  288. 
Krause,  Prof.,  165. 


Lambourne,  Lord,  186. 
Lane,  Sir  Arbuthnot,  121. 
Lane-Claypon,  Dr.  Janet,  265. 
Lankester,  Sir  E.  Ray,  45. 
Lannelongtie,  Dr.,  141,  199. 

Prize,  199. 

Larynx,  central  motor  innervation  of, 

110-112. 
Lateral  sinus,  septic  thrombosis  of,  121. 
Lees  and  Raper  Lecture,  170,  232. 
Leifihton,  Lord,  45. 
Leipzig,  visit  to  (1881),  41. 
Leith,  Prof.,  125. 

Le  Mare,  Capt.,  H.M.S.  Delta,  295. 
Lendon,  Dr.  Alfred,  15,  18,  287. 


INDEX 


355 


Leontiasis  ossium,  157. 
Levy,  Dr.  Alfred,  175. 
Leyden,  Prof.,  153. 
Linacrc  Lecture,  no,  193. 
Lister  Institute,  53. 

Lord,  6(),  236,  259,  279. 

Lodge,  Sir  Oliver,  15. 

Loeweathal,  Dr.  Max,  164. 

Logie,  Mr.  Jobn,  267. 

London,    rabies   and   hydrophobia   in, 

(1884-1890),  78-81. 
Long,  Mr.  Walter,  87. 
Lowenstein,  Miss,  235. 
Luzford,  Lt.-Col.,  309. 
Luxor,  307. 

M 

McCarrison,  Colonel,  LM.S.,  303,  505, 

318,  326. 
McDowall,  Major,  295. 
Macewen,  Sir  William,  118. 
McGrigor,  Sir  James,  250. 
McKenna,  Mr.,  204. 
Mackenzie,  Dr.  Hector,  66. 
Mackworth,  Major,  LM.S.,  338. 
MacNalty,  Dr.  A   Salusbury,  113,  143, 

176,  191,  243. 
Magnus  of  Cbristiania,  179. 

Sir  Philip,  15,  197. 

Manifold,  Colonel,  LM.S.,  310. 
Mann,  Dr.  Gustav,  176. 
Marchi's  method,  171. 
Marcbiafava,  Prof.,  45. 
Marinesco,  Dr.  Georges,  123. 
Marshall,  Prof.  Alfred,  242. 

-  Mr.  John,  36,  49. 
Marten,  Dr.  R.  H.,  27,  40,  43. 
Martin,  Prof.  Sidney,  29,  160. 

'  Mass  meeting  '  at  Queen's  Hall  (Na- 
tional Insurance  Act),  227. 
Matthews,  Pte.  J.  R.,  298. 
Maudsloy,  Sir  Henry,  37,  309. 
.Mauritius,  rabies  in,  74. 
May,  Mr.  Edward,  301. 

Dr.  Otto,  196,  228. 

Medical  Acts,  the,  164,  165,  215. 
Companies,  registration  of,  219. 

Defence  Union,  213-216. 

Licensing  Bodies,  219. 

Research  Club,  144,  145. 

Medicated  wines,  the  trade  in,  246. 

Medico-ethical  Societies,  171. 

Medico-legal  Society,  the,  191. 

Meningitis,  chronic  spinal,  191. 

.Mi-riietsch,  Staff-Surgeon,  251. 

Mersa  .Matruh,  Horsley  at,  ^04,  311. 

Mesopotamia,  318-340  :  Indian  Govern- 
ment Commission,  317,  320,  323  : 
British  Goverun^  nt  Commission, 
323,  336  :    at  the  Iront,  322,  336. 

Microcephalic  idiocy,  operative  treat- 
ment of,  141. 

Midwives,  registration  of,  168,  212,  3ift. 

Millais.  Sir  Everett,  84. 

Mitchell  Banks  Memorial  Lecture,  289. 

Money,  Dr.  Angel,  29. 

'  Morbid  Anatomy '  I'rrsws  Experimental 
Pathology,  144. 


Motor  centres,  tiic  nature  of,  116,  193. 
Motoring  expeditions,  264. 
Mott,  Sir  F.  W.,  28,  29,  175,  193. 
Moullin,  Mr.  Mansell,  21. 
Mudros,  Horsley  at,  303. 
Munk,  Prof.,  97,  197. 
Murray,  Prof.  George,  65. 
Muzzling  Order,  the,  87. 
Myxcedema,  54-67. 


N 

National  Insurance  .Act,  224-229. 
Navv,  reduced  use  of  rum  in  the,  249. 
Neale,  Dr.  W.  H.,  i«,  264.  ^ 
Nerve-energy,   Horsley's  measurement 

of,  166. 
Nerve-stretching  :  Mr.  Marshall's  Brad- 

shaw  Lecture,  49. 
'  Nervi  nervorum,'  Horsley's  paper  on 

(1884),  30. 
Nervous  Diseases  Research  Fund,  172. 
Neuralgia,  trigeminal,  operative  treat- 
ment of,  142, 165, 192. 
Neurological    Society,    115,    I37i    I44f 

160,  282,  288. 
Neurology,  Experimental,  160. 
Newman,  Sir  George,  236. 
Nobel    Prizes :     Horsley   proposed    for 

one,  297. 
Noble,  Sir  Andrew,  155. 
Non-excitable  zones  of  cortex  cerebri, 

Horsley's  theory  of,  no. 
Norman,  Sir  Henry  and  Lady,  289,  291. 
North  Islington  :    Horsley  adopted  »s 

Liberal  candidate,  200. 
Nothnagel  Lecture,  275,  297. 
Nurses,  registration  of,  224. 
Nursing  Homes,  272. 

the  College  of,  224. 

under  the  Insurance  Act,  210. 


O 

Oidenia,  experimental  study  of,  149. 

Ogilvie,  Capt.,  251. 

Oldfield,  Mrs.,  313. 

O'Neills,  the,  10. 

Ophthalmological      Congress,     Oxford 

(1908),  188. 

Society,  141,  188. 

Opium     trafl&c.     National     Conferente 

against,  201. 
Oppenheini,  Mr.,  42. 
Optic  neuritis  in  cases  of  tumour  of  the 

brain,  162,  184,  188,  192. 
Orang-outang  :    experimental  study  of 

brain,  107. 
Ord,  Dr.  William,  55. 
Ortlcr..f  the  Bath,  honour  of  (191 6),  397. 
Orientatiitn  of  points  iu  space,  clinical 

study  of,  i8i. 
Owens  College,  Manchester,  138. 
Oxidation     in     living     tissues,    experi- 
mental stuily  of,  152.  157.  '63. 
Oxygen,  adjustment  of  cylinder  to  the 

Vernon  Harcourt  inhaler,  184. 


OD' 


S6 


SIR  VICTOR  HORSLEY 


*  Pacinian  bodies'  in  muscles,  164. 
Page,  Mr.  Frederick,  126. 
Paget,  Miss,  72. 

Sir  James,  68-76. 

Paralytic  rabies  in  man,  77  :  in  rabbits, 

82. 
Par6,  Ambroise,  117,  279. 
Park    Street,    Grosvenor    Square,   the 

Horsleys'  house  in,  115. 
Parker,  Mr.  Kushton,  18. 
Parkin,  Mr.  Alfred,  158. 
Pasteur,  27,  68-89. 

Dr.  William,  15. 

Patellar  knee-jerk,  Horsley's  paper  on, 

41- 
Pathological  Society,  144. 
Patients,     in     Hospital     and     private 

practice,  267-271. 
Pearce,  Mr.  Walter,  32,  35,  230. 
Pearson,  Prof.  Karl,  239-243. 
Peel  Report,  the,  234. 
Penberthy,  Prof.,  84. 
Penrose,  Dr.  Frank,  45. 
Personation,  not  of  itself  a  legal  ofience, 

218. 
Petren,  Prof.,  of  Stockholm,  297. 
Philomathic  Society,  the,  30. 
Phrenology,  true  and  false,  188. 
Phthisis,    Horsley   threatened   with   it 

(i88i),  39. 
Physical  Deterioration,  Commission  on, 

173- 
Physiological  Society,  144,  265. 
Pierre  Marie,  on  acromegaly,  123. 
Pituitary  body  :    experimental  study, 

123  :   operation,  160. 
'  Pledge  '  of  conditions  of  service  under 

the  National  Insurance  Act,  225. 
Pleuro-pneumonia     of     cattle.     Com- 
mission on,  85,  133. 
Pollard,  Mr.  Bilton,  18. 
Port  Said  to  Bombay,  313. 
Power,  Mr.  J.  Dan  vers,  90,  170,  172. 
Practice,  addresses  on,  141,  158. 

falling  off  before  the  War,  272. 

Prevention    of    Hydrophobia,    Society 

for,  84-89. 
Projectiles :     experimental    study    of 

destructive  effects,  152-157,  266. 
'  Pure  Science  '  and  Practice,  50. 


Quain's  Anatomy,  44. 

Quain,  Sir  Richard,  69. 

tjueen  Square  Hospital,  116,  120,  122  : 
cases  at,  162  :  difficulties  of  manage- 
ment, 169  :  research  fund,  172  : 
festival  dinner,  186  :  analysis  of 
cases  at,  201  :  women  admitted  to 
its  practice,  204. 

Queen's  Hall  :  siififraRc  meeting,  204  : 
'  mass  meeting  '  at  doctors,  227. 

Quma  (Mesopotamia),  321. 

R 

Rabbit's  ear  :  reflex  movement  of,  178. 
Rabies  (hydrophobia),  68-89. 


Radclilte,  Dr.,  142. 

Radium,  experimental  studf  ot,  199. 

Ramon  y  Cajal,  Dr.,  193. 

Ranvier,  Dr.,  149. 

Rcay,  Lord,  68. 

Rebus  of  the  little  horse,  129. 

Reissner's  fibre  in  the  brain  of  the 
monkey,  189. 

Representation  and  re-representation, 
179,  181. 

Research  Defence  Society,  188. 

Respiratory  failure  preceding  heart 
failure  in  cerebral  cases,  153-157. 

Responsibility  of  Manhood  :  a  Brother- 
hood address,  257. 

Reverdin,  Prof.,  57. 

Richet,  Prof.,  90. 

Richmond  Park  :  264  deer  with  rabies 
(1886-87),  81. 

Ridsdale,  Mr.,  316. 

Robinson,  Captain,  291. 

Colonel,  295. 

Rogers,  Sir  Leonard,  237. 

Roman  Defences  of  South-East  Britain, 
lecture  on,  167  :  the  Great  Roman 
Wall,  275- 

Romanes,  Prof.,  84,  139. 

Rome  in  1882,  Horsley's  account  of,  46. 

Roscoe,  Sir  Henry,  69,  70. 

Rose,  Mr.  William,  165. 

Rousay,  holidays  at,  266,  267. 

Roy,  Prof.,  51. 

Royal  Prussian  Academy  of  Sciences, 
196. 

Society  :  nomination,  72  :  elec- 
tion, 123  :  gold  medal,  152. 

of  Science  of  Upsala,  200. 

Rum  ration,  the,  246-251. 

Russel,  Dr.  Colin,  183. 

Russell,  Dr.  J.  Risien,  164, 178,194,264. 

Russian  Surgical  Society,  187. 

Ryle,  Dr.  R.  J.,  242. 


Sachs,  Prof.  Ernest,  190. 

Sainsbury,  Dr.  Harrington,  30. 

Salecby,  Dr.,  251. 

Sandwith,  Colonel,  307. 

Sargent,  Mr.  Percy,  117. 

Savage,  Sir  George,  165. 

Savill,  Dr.  Agnes,  200. 

Schafer,  Mrs.,  33,  44,  47-50,  72. 

Sir    E.  Sharpey,  17,  59,  94,  96, 

115,  128,  188. 

Schiff,  Prof.,  59,  61,  64,  123. 

School  children,  medical  care  of,  223, 
229  :  teaching  of  hygiene  and  tem- 
perance, 224,  236-238  :  dental  clinics, 
234. 

'  Seat  of  the  soul,'  the,  90. 

Semon,  Sir  Felix,  58,  95,  no,  128, 
138,  197. 

'  Septic  bacteria,'  Horsley's  report  to 
Local  Government  Board,  44. 

Seventeenth  General  Flospital,  30J, 
306,  307,  309. 

Shaik  Saad  (Mesopotamia),  323. 

Shaw,  Mr.  Bernard,  191. 

Sheffield  Medical  School,  158. 


INDEX 


357 


Sherran,  Major,  290. 

SherringtoD,  Prof.,  51,  no,  192,  1)4. 

Sbuter,  Dr.  G.  P.,  156. 

Silk,  Dr.  J.  F.  W.,  i8. 

Simla,  316,  318. 

Sloggett,  Sir  Arthur,  289. 

Smoking,  arguments  against,  23,  46. 

Soci6t6  de  Chirurgie  de  Paris,  157,  199. 

Soury,  Prof.,  90. 

Southampton  to  Alexandria,  295,  296. 

Spencer,  Mr.  Walter  G.,  95,  137,  138. 

Spinal  cord  :  experimental  study  of, 
134-136,  139  :  removal  of  tumour 
from,  126 :  compression-myelitis, 
149  :   chronic  spinal  meningitis,  191. 

Spitzka,  Dr.,  188. 

Starling,  Prof.,  151. 

State-regulation  of  vice,  201,  210. 

Stereognosis,  clinical  study  of,  194. 

Stereotaxic  apparatus,  R.  H.  Clarke's, 
189. 

Stone  Age,  trephining  in  the,  123. 

Storry,  Mr.,  167. 

Students'  Societies,  Univ.  Coll.,  ifl,  24. 

Sturge,  Dr.  Mary,  229,  235-237,  243, 
287,  303. 

'  Surgical  cases  '  and  '  medical  cases,' 
145,  170. 

Surgical  Registrarship,  43,  47. 

Surrey,  rabies  in,  79. 

Swayne,  Mr.  Martin,  340. 

Sympathy  in  Public  Affairs  :  a  Brother- 
hood address,  257. 


Tactile  sensation,  clinical  study  of,  175. 

Taenia  pontis,  experimental  study  of 
the,  181. 

Tait,  Mr.  Lawson,  214. 

Taxation  of  Land  Values,  Association 
for,  207,  2  75- 

Taylor,  Mr.  Everley,  162. 

Dr.  James,  141. 

Temperance  :  early  lectures  on,  250  : 
National  Temperance  League,  231  : 
British  Medical  Temperance  Assoc., 
231  :  Internl.  Assoc,  of  Abstaining 
Physicians,  239  :  National  Temper- 
ance l-ederation,  246  :  Irish  Temper- 
ance League,  239  :  True  Temper- 
ance Ass^jc.,  251  :  British  Women's 
Temperance  Ass<jc.,  192:  'Temper- 
ance breakfasts,'  the,  234. 

Temperature  :  difference  between  two 
sides  of  the  body,  in  cases  of  injury 
to  the  brain,  137. 

Thane,  Sir  George,  17. 

Thiele,  Dr.,  170. 

Third  London  Hospital,  286. 

Thompson,  Dr.  Sclh,  3. 

Tiivroid  Klan'l,  the,  54-67. 

Titles,  the  use  of  medical,  2i8. 

Tomes,  Sir  Cliarlcs  S.,  217. 

Tooth,  Dr.  Howard,  201. 

Topognosis,  clinical  study  of,  175,  181. 

Toronto  Meeting;,  Brit.  M-d.  Assoc. 
(1906),  I. S3, 

Torticollis,  operative  treatm<-iit  of,  164. 


Tracheotomy,  a  case  of,  37. 

Trade-unions  and  Professions,  213 
223,  228. 

Trained  Nurses,  National  Council  of, 
209. 

Transplantation  of  thyroid  tissue,  61, 
64. 

Tree  of  Knowledge  (Mesopotamia),  321. 

Treherne,  General,  325,  326,  332,  336. 

Trephining,  prehistoric,  123. 

Trigeminal  nerve,  mesencephalic  root 
of,  196. 

neuralgia,  operative  treatment  of, 

142,  165, 192. 

Trotter,  Mr.  Wilfred,  161. 

Trypanosoraes,  early  study  of,  45. 

Tubby,  Colonel,  301. 

Tubercle  and  tuberculin,  40,  44  :  tuber- 
culosis in  cattle,  134. 

Tubercular  retinitis,  early  study  of,  28. 

Tumours,  early  experimental  study  of, 

43- 
Turuer,  Dr.  Aldren,  178. 

Mr.  Edward  B.,  209. 

Major  Grey,  339. 

Mr.  J.  Sidney,  87,  89. 

Tuke,  Mr.  William,  32,  39. 
Twenty-first    General    Hospital,    289, 

294-300. 
Twort,  Mr.  F.  W.,  51. 
Twynam,  Dr.  G.  E.,  40. 
Tyndall,  Prof.,  27,  68,  84,  127. 
Typhoid,  protective  treatment  against, 

296,  299. 

U 

Universities,  purposes  and  maintenance 
of,  172. 

University  College,  debating  societies, 
i8,  24,  30,  46  :  Department  of  Path- 
ology, 43,  116,  159  :  Department  of 
Experimental  Neurology,  160. 

College  Hospital,  27,  36,  43,  114, 

145,  168,  179. 

of   London:     examinations,   41: 

Senate,  163  :  Parliamentary  repre- 
sentation, 197. 

Unrcjjistered  places  (Cruelty  to  Animals 
Act),  176. 


Venereal  diseases,  173,  209 

Vcssale,  Dr.  G,  65,  66. 

Vcra>;uth,  Dr.,  166. 

Veterinary  surgery,  51,  269. 

Villa  \'asiiiiii,  301. 

Villeuiiii's  study  of  tuberculosis,  78. 

Virchow,  Prof  ,  285. 

Virchow's  leslschrilt,  143. 

'  Virus  (ixe  '  of  rabies,  83. 

Vizards,  the,  lo. 

W 

Waldeycr,  Prof.,  138,  197. 
WallT  s  Law,  171. 
Walrus,  brain  of,  190. 
Waller,  Mlss  Elvira,  4. 


358 


SIR  VICTOR  HORSLEY 


Wanhill,  Major,  318. 

War    Ofifice :      Horsley's    memoranda 

(1914),  288. 
de  Watteville,  Dr.,  115. 
Waugh,  Dr   H.  D.,  30. 
West,  Mr.  C.  E.,  200. 
West  London  Med.  Chir.  Society,  192. 
Whitaker,  Mr.  Smith,  226. 
Whitehead,  Sir  James,  77. 
Whitelegge,  Sir  Arthur,  46,  77. 

Lady,  5. 

Whitmore,  Mr.  Charles  A.,  88. 
WiJlcox,  Colonel,  325. 
Willeslcy,  5-14,  22,  48,  326. 
Williams,  Dr.  Dawson,  29. 
Willingdon,  Lord  and  Lady,  314,  316. 
Wimbledon  Medical  Society,  175. 


Wimerevix,  290-294. 

Wirgmans,  Dr.,  168. 

Woodhead,  Sir  George  Sims,  139,  183. 

Wooldridge,  Prof.,  144,  149,  i5i- 

Women's  Liberal  Association,  292. 


x-ray   apparatus,    deficient    in    Egypt 
(1915),  30O1  301- 


Yeo,  Dr.  Gerald,  94. 


Zoological  Gardens,  190,  237,274,  175- 


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